1942475207 NPI number — CHEYENNE WORKMAN RD CD

Table of content: CHEYENNE WORKMAN RD CD (NPI 1942475207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942475207 NPI number — CHEYENNE WORKMAN RD CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORKMAN
Provider First Name:
CHEYENNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD CD
Provider Gender Code:
F

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:
1942475207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
778 S MORRISTOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46140-7885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-969-2429
Provider Business Mailing Address Fax Number:
765-779-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6145 N 940 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-620-8400
Provider Business Practice Location Address Fax Number:
765-779-4010
Provider Enumeration Date:
04/28/2008

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: 133V00000X , with the licence number:  37001827 , 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: 37001827 . This is a "INDIANA CERTIFICATION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200881730 . This is a "FIRST STEPS PROVIDER NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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