1598859605 NPI number — DR. PAMELA JO GRANT D.C.

Table of content: ERIN KERN RN,BSN,IBCLC (NPI 1922826338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598859605 NPI number — DR. PAMELA JO GRANT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
PAMELA
Provider Middle Name:
JO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEHIN
Provider Other First Name:
PAMELA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598859605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
585 SHERIDAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOBLESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46060-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-219-0354
Provider Business Mailing Address Fax Number:
317-219-3083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 SHERIDAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46060-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-219-0354
Provider Business Practice Location Address Fax Number:
317-219-3083
Provider Enumeration Date:
10/03/2006

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: 111N00000X , with the licence number:  08002113A , 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: 331140672-01 . This is a "SAGAMORE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 703858 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200838160 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000504008 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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