1770819872 NPI number — FLYWHEEL HEALTHCARE LLC

Table of content: (NPI 1003133026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770819872 NPI number — FLYWHEEL HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLYWHEEL HEALTHCARE LLC
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:
1770819872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46082-3504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-308-4990
Provider Business Mailing Address Fax Number:
877-513-6937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10330 N MERIDIAN ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-308-4990
Provider Business Practice Location Address Fax Number:
877-513-6937
Provider Enumeration Date:
10/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
317-213-5117

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X , with the licence number:  265197 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NRP.022459650-12 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHNR.FO.60319761 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 60006208A , 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: 2122500 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200962160A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".