1851376388 NPI number — MRS. NORMA J KREILEIN MD

Table of content: MRS. NORMA J KREILEIN MD (NPI 1851376388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851376388 NPI number — MRS. NORMA J KREILEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREILEIN
Provider First Name:
NORMA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1851376388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 760
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47501-0760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-254-7310
Provider Business Mailing Address Fax Number:
812-257-8602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-7310
Provider Business Practice Location Address Fax Number:
812-257-8602
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  01037533 , 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: 100110590A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450494518101 . This is a "CARE SOURCE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100270240C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000291248 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100270240A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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