1740510924 NPI number — ST. JOSEPH CO. AIRPORT AUTHORITY

Table of content: DR. JASON CHRISTOPHER STIBICH M.D. (NPI 1619905882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740510924 NPI number — ST. JOSEPH CO. AIRPORT AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOSEPH CO. AIRPORT AUTHORITY
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:
6
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:
1740510924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4821 LINCOLN WAY W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46628-5525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-282-4593
Provider Business Mailing Address Fax Number:
574-282-4592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4821 LINCOLN WAY W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46628-5525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-282-4593
Provider Business Practice Location Address Fax Number:
574-282-4592
Provider Enumeration Date:
01/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ORNAT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
574-282-4593

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  0444 , 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)





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