1811165269 NPI number — THERACARE INC

Table of content: (NPI 1811165269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811165269 NPI number — THERACARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERACARE INC
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:
PEDIATRICS, ORTHOPEDICS AND SPINE THERAPY CENTER
Provider Other Organization Name Type Code:
3
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:
1811165269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9957 ALLISONVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46038-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-841-7005
Provider Business Mailing Address Fax Number:
317-841-7029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 LINCOLN WAY WEST
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
OSCEOLA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46561-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-675-7767
Provider Business Practice Location Address Fax Number:
574-675-9344
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
317-841-7005

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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