1033422522 NPI number — ABOITE CIVIL TOWNSHIP

Table of content: (NPI 1033422522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033422522 NPI number — ABOITE CIVIL TOWNSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABOITE CIVIL TOWNSHIP
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:
1033422522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11321 ABOITE CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46814-5472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-432-0970
Provider Business Mailing Address Fax Number:
260-436-9747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11321 ABOITE CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46814-5472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-432-0970
Provider Business Practice Location Address Fax Number:
260-436-9747
Provider Enumeration Date:
07/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KRISHER
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
TRUSTEE
Authorized Official Telephone Number:
260-432-0970

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100288330 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590010043 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".




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