1619970183 NPI number — MICHIANA HEMATOLOGY-ONCOLOGY P C

Table of content: (NPI 1619970183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619970183 NPI number — MICHIANA HEMATOLOGY-ONCOLOGY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIANA HEMATOLOGY-ONCOLOGY P C
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:
1619970183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-334-5400
Provider Business Mailing Address Fax Number:
574-237-1348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5340 HOLY CROSS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-237-1328
Provider Business Practice Location Address Fax Number:
574-237-1348
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANSARI
Authorized Official First Name:
BILAL
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
574-237-1328

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100389430H , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300009110 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB52227 . This is a "RRMC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100389430C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1560297 . This is a "NCPDP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100389430M , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100389430J , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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