1598750986 NPI number — DR. MICHAEL S HERRON MD

Table of content: DR. MICHAEL S HERRON MD (NPI 1598750986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598750986 NPI number — DR. MICHAEL S HERRON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRON
Provider First Name:
MICHAEL
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598750986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINCENNES
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47591-1038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-885-3344
Provider Business Mailing Address Fax Number:
812-885-3811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINCENNES
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47591-1038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-885-3344
Provider Business Practice Location Address Fax Number:
812-885-3811
Provider Enumeration Date:
09/13/2005

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: 207P00000X , with the licence number:  01057599A , 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: 003230 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036107791 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 624302 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200450570 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2168888 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5132004 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1729885 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com