1619105244 NPI number — COMMUNITY PHYSICIANS OF INDIANA INC

Table of content: (NPI 1619105244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619105244 NPI number — COMMUNITY PHYSICIANS OF INDIANA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY PHYSICIANS OF INDIANA INC
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:
1619105244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7240 SHADELAND STATION
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-355-5555
Provider Business Mailing Address Fax Number:
317-355-8716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7240 SHADELAND STATION
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-3944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-355-5555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
YELETI
Authorized Official First Name:
RAMARAO
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP
Authorized Official Telephone Number:
317-355-5555

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200969250A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250E , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201018890G , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000647913 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200969250L , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250H , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250K , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250M , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201006200O , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250F , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250I , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250J , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200969250G , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201014430T , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com