1912955378 NPI number — MRS. SUSAN LOUISE SWINDEMAN OTR BCP

Table of content: MRS. SUSAN LOUISE SWINDEMAN OTR BCP (NPI 1912955378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912955378 NPI number — MRS. SUSAN LOUISE SWINDEMAN OTR BCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWINDEMAN
Provider First Name:
SUSAN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR BCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIANA
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912955378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 EDMOND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DYER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46311-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-322-1415
Provider Business Mailing Address Fax Number:
219-322-1414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 EDMOND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DYER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46311-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-322-1415
Provider Business Practice Location Address Fax Number:
219-322-1414
Provider Enumeration Date:
05/05/2006

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: 225X00000X , with the licence number:  31001495A , 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: 200716000A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200645500 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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