1922054535 NPI number — MELISSA BADAR BEYFUSS CRNA

Table of content: MELISSA BADAR BEYFUSS CRNA (NPI 1922054535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922054535 NPI number — MELISSA BADAR BEYFUSS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEYFUSS
Provider First Name:
MELISSA
Provider Middle Name:
BADAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BADAR
Provider Other First Name:
MELISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922054535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46581-1296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-268-9640
Provider Business Mailing Address Fax Number:
574-268-0684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9002 N MERIDIAN ST
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:
46260-5381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-268-9640
Provider Business Practice Location Address Fax Number:
574-268-0684
Provider Enumeration Date:
05/25/2006

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: 367500000X , with the licence number:  28106139A , 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: P00760810 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200308610 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000670869 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1922054535 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2009294 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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