1700127800 NPI number — JANET M BUHSE MD PC

Table of content: MRS. TRACEY LYNN COLEMAN PHD (NPI 1740465434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700127800 NPI number — JANET M BUHSE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANET M BUHSE MD PC
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:
1700127800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
941 W MCCLAIN AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47170-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-752-7705
Provider Business Mailing Address Fax Number:
812-752-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
941 W MCCLAIN AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-752-7667
Provider Business Practice Location Address Fax Number:
812-752-7687
Provider Enumeration Date:
03/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BUHSE
Authorized Official First Name:
JANET
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
812-752-7667

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01058165A , 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: 200444280A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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