1083998447 NPI number — MR. NICHOLAS GREGORY BUTCHER M.S.

Table of content: MR. NICHOLAS GREGORY BUTCHER M.S. (NPI 1083998447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083998447 NPI number — MR. NICHOLAS GREGORY BUTCHER M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTCHER
Provider First Name:
NICHOLAS
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
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:
1083998447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W KIRKWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47404-6129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-219-6007
Provider Business Mailing Address Fax Number:
812-334-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W KIRKWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47404-6129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-219-6007
Provider Business Practice Location Address Fax Number:
812-334-3885
Provider Enumeration Date:
10/04/2011

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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