1912990268 NPI number — CITY OF TERRE HAUTE

Table of content: PATRICIA ANNE COONEY CRNA (NPI 1720036023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912990268 NPI number — CITY OF TERRE HAUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF TERRE HAUTE
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:
Provider Other Organization Name Type Code:
6
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:
1912990268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 HARDING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47807-3427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-234-8693
Provider Business Mailing Address Fax Number:
812-234-0924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
559 W MARGARET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-3788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-244-2801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUTHER
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY CHIEF OF EMS
Authorized Official Telephone Number:
812-244-2811

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0064 , 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: 100282090 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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