1023024379 NPI number — MRS. JANINE B BOIVIN P.A.-C

Table of content: MRS. JANINE B BOIVIN P.A.-C (NPI 1023024379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023024379 NPI number — MRS. JANINE B BOIVIN P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOIVIN
Provider First Name:
JANINE
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BISHARA
Provider Other First Name:
JANINE
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023024379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46143-1049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-807-1262
Provider Business Mailing Address Fax Number:
317-859-4268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12188A N MERIDIAN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-564-5100
Provider Business Practice Location Address Fax Number:
317-564-5556
Provider Enumeration Date:
07/31/2006

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: 363A00000X , with the licence number:  10000492A , 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: 970019595 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1487680518 . This is a "GROUP NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000340608 . This is a "ANTHEM PIN NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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