1922085315 NPI number — DR. DONALD PAUL WARREN DC

Table of content: (NPI 1023370285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922085315 NPI number — DR. DONALD PAUL WARREN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
DONALD
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1922085315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSCEOLA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46561-0139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-679-0100
Provider Business Mailing Address Fax Number:
574-675-9586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5432 LINCOLNWAY EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSCEOLA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-679-0100
Provider Business Practice Location Address Fax Number:
574-675-9586
Provider Enumeration Date:
12/27/2005

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: 111N00000X , with the licence number:  08001279 , 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: 000000089524 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100468590 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168920 . This is a "PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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