1912183492 NPI number — HEALTH 1ST OF ANDERSON

Table of content: (NPI 1912183492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912183492 NPI number — HEALTH 1ST OF ANDERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH 1ST OF ANDERSON
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:
HEALTH 1ST PHYSICAL REHABILITATION
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:
1912183492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2976 N SCATTERFIELD RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46012-1585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-643-8781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2976 N SCATTERFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46012-1585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-643-8781
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUNHAM
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
765-643-8781

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001691A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 01047723A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 05008202A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200108320 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275552481 . This is a "NPI#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1184794901 . This is a "NPI#" identifier . This identifiers is of the category "OTHER".




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