1609198266 NPI number — ADVANCED PRIMARY CARE ASSOCIATES

Table of content: MRS. ELIZABETH KAY WOLKENHAUER JENSEN PHARMD (NPI 1437368008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609198266 NPI number — ADVANCED PRIMARY CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PRIMARY CARE ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1609198266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9840 WESTPOINT DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-577-6056
Provider Business Mailing Address Fax Number:
317-577-6059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9840 WESTPOINT DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-577-6056
Provider Business Practice Location Address Fax Number:
317-577-6059
Provider Enumeration Date:
02/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
317-577-6056

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01047166A , 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: 200213060 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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