1093768913 NPI number — MRS. DONNA C SWEETS DO

Table of content: MRS. DONNA C SWEETS DO (NPI 1093768913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093768913 NPI number — MRS. DONNA C SWEETS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEETS
Provider First Name:
DONNA
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1093768913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 359
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47703-0359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-485-1220
Provider Business Mailing Address Fax Number:
812-485-8544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 SAINT MARYS DR
Provider Second Line Business Practice Location Address:
SUITE 309E
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-0511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-485-1850
Provider Business Practice Location Address Fax Number:
812-485-1855
Provider Enumeration Date:
05/19/2006

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: 207V00000X , with the licence number:  02002168 , 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: 000000485714 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 237890 . This is a "MEDICARE GRP #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 65945420 . This is a "MEDICAID GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: DF3251 . This is a "RAILROAD GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 205023387 . This is a "TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200264690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200829650A . This is a "MEDICAID GRP #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 64095243 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00362823 . This is a "RAILROAD INDIVIDUAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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