1639278542 NPI number — FRED H FRANCIS II MD

Table of content: FRED H FRANCIS II MD (NPI 1639278542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639278542 NPI number — FRED H FRANCIS II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANCIS
Provider First Name:
FRED
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
II
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:
1639278542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 W WHITE RIVER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47303-4988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47303-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-747-3148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006

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: 2085R0001X , with the licence number:  01050991 , 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: 000000591643 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1487680518 . This is a "GROUP NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100194370 . This is a "GROUP MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200288740 . This is a "GROUP MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200287630 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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