1043345820 NPI number — DRS BORISH BURKHART & REID INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043345820 NPI number — DRS BORISH BURKHART & REID INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS BORISH BURKHART & REID 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:
DRS. CALVIN AND BURKHART
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:
1043345820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 W LINCOLN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KOKOMO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46902-3481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-453-2907
Provider Business Mailing Address Fax Number:
765-453-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 W LINCOLN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46902-3481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-453-2907
Provider Business Practice Location Address Fax Number:
765-453-6111
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CALVIN
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
765-453-2907

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  56000005A , 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: 100135900A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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