1043279813 NPI number — OHIO VALLEY COLON & RECTAL SURGEONS, INC.

Table of content: (NPI 1043279813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043279813 NPI number — OHIO VALLEY COLON & RECTAL SURGEONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO VALLEY COLON & RECTAL SURGEONS, INC.
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:
1043279813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 SAINT MARYS DR
Provider Second Line Business Mailing Address:
STE 300 W
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47714-0511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-477-9241
Provider Business Mailing Address Fax Number:
812-474-6708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 ST. MARY'S DRIVE WEST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-0560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-477-9241
Provider Business Practice Location Address Fax Number:
812-474-6708
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALLER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
VICE-PRESIDENT/SECRETARY
Authorized Official Telephone Number:
812-301-8110

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  50002315A , 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: 65908493 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000056135 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100246770A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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