1528463007 NPI number — DR. SARA LYNN KOVACIC D.O.

Table of content: ROCHELE SHERMAN (NPI 1326719287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528463007 NPI number — DR. SARA LYNN KOVACIC D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVACIC
Provider First Name:
SARA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PACE
Provider Other First Name:
SARA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528463007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 SEVEN SPRINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7906
Provider Business Mailing Address Fax Number:
615-920-8775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N 16TH ST STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47362-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-599-3555
Provider Business Practice Location Address Fax Number:
765-599-3286
Provider Enumeration Date:
10/27/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  02004545A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02004545B . This is a "CSR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100392520 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201280210 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02004545A . This is a "STATE LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".