1801816673 NPI number — BROWNSBURG FAMILY MEDICAL CENTER, P.C.

Table of content: (NPI 1801816673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801816673 NPI number — BROWNSBURG FAMILY MEDICAL CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWNSBURG FAMILY MEDICAL CENTER, 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:
1801816673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SOUTHFIELD DR
Provider Second Line Business Mailing Address:
SUITE 1370
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46168-4498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-837-5571
Provider Business Mailing Address Fax Number:
317-837-5580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 NORTHFIELD DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BROWNSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46112-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-852-6065
Provider Business Practice Location Address Fax Number:
317-852-2468
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLAYER
Authorized Official First Name:
GENIEVEE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
NETWORK DIRECTOR
Authorized Official Telephone Number:
317-837-5571

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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