1003324120 NPI number — HUNTINGTON HEALTHCARE ASSOCIATES LLC

Table of content: (NPI 1003324120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003324120 NPI number — HUNTINGTON HEALTHCARE ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON HEALTHCARE ASSOCIATES LLC
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:
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:
1003324120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 HOME STREET
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46750-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-355-7411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 HOME STREET
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-355-7411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PINKERTON
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
260-355-7411

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  71007734A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: 71007734A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300010270 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".