1033190566 NPI number — NORTHERN INDIANA AMBULATORY SURGERY CENTER

Table of content: (NPI 1033190566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033190566 NPI number — NORTHERN INDIANA AMBULATORY SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN INDIANA AMBULATORY SURGERY CENTER
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:
RIVERPOINTE SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1033190566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ARCADE AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46514-2477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-522-9505
Provider Business Mailing Address Fax Number:
574-296-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ARCADE AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46514-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-522-9505
Provider Business Practice Location Address Fax Number:
574-296-6484
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CLARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
574-522-9505

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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: 000000098159 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200161520 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490003441 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 14470 . This is a "PHP PHYSICIANS HEALTH PLA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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