1902894074 NPI number — THOMAS HABIMANA CRNA

Table of content: (NPI 1669057279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902894074 NPI number — THOMAS HABIMANA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABIMANA
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1902894074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11460 N MERIDIAN ST
Provider Second Line Business Mailing Address:
STE. 110
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-4408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-567-2180
Provider Business Mailing Address Fax Number:
317-614-9655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3630 GUION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46222-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-920-8439
Provider Business Practice Location Address Fax Number:
317-614-9655
Provider Enumeration Date:
10/12/2005

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: 367500000X , with the licence number:  1097396 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 28122164A , 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: 2773493000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 430080249 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200428210 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50012416 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000283641 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 74005273 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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