1053394023 NPI number — GEORGE PATRICK MCGHEE M.D.

Table of content: GEORGE PATRICK MCGHEE M.D. (NPI 1053394023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053394023 NPI number — GEORGE PATRICK MCGHEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGHEE
Provider First Name:
GEORGE
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1053394023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 HILLVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47111-8967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-256-0437
Provider Business Mailing Address Fax Number:
812-256-6893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47111-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-256-3381
Provider Business Practice Location Address Fax Number:
812-256-6893
Provider Enumeration Date:
11/23/2005

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: 207Q00000X , with the licence number:  01056332A , 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: 200367230A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011760461 . This is a "RAILROAD MEDICARE ID#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351516588 . This is a "TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000246515 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 140407 . This is a "CRIPPLED CHILDREN ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 011760461 . This is a "METRA HEALTH RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 255220 . This is a "MEDICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".




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