1013902543 NPI number — ANGELA G PENCE MD

Table of content: ANGELA G PENCE MD (NPI 1013902543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013902543 NPI number — ANGELA G PENCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENCE
Provider First Name:
ANGELA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1013902543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9998 CROSSPOINT BLVD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-579-2150
Provider Business Mailing Address Fax Number:
317-579-2130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9998 CROSSPOINT BLVD STE 200
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:
46256-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-579-2150
Provider Business Practice Location Address Fax Number:
317-579-2130
Provider Enumeration Date:
09/12/2005

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: 2085R0202X , with the licence number:  1046191 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 01046191A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 01046191A , 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: P00032459 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032639 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200197350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300131511 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00032678 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032681 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00257531 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032507 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032969 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00033122 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000219647 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00032457 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032458 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032640 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032679 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032756 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".




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