1184912370 NPI number — FMMG LLC

Table of content: (NPI 1184912370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184912370 NPI number — FMMG LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FMMG LLC
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:
1184912370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 HIGHLANDER POINT DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOYDS KNOBS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47119-9465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-542-4906
Provider Business Mailing Address Fax Number:
812-948-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-4990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-542-4906
Provider Business Practice Location Address Fax Number:
812-949-5966
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
EICHENBERGER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
812-542-4921

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8891986 . This is a "PHCS/MULTIPLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 9213755 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000729479 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: DS6609 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100200500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9213755 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201039920A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127750 . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201207730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3361514 . This is a "UNITED" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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