1225168404 NPI number — GIRAGOS HEART AND VASCULAR CENTER

Table of content: (NPI 1225168404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225168404 NPI number — GIRAGOS HEART AND VASCULAR CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIRAGOS HEART AND VASCULAR CENTER
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:
1225168404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 MACARTHUR BLVD
Provider Second Line Business Mailing Address:
SUITE 25
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-1200
Provider Business Mailing Address Fax Number:
219-836-1252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-1200
Provider Business Practice Location Address Fax Number:
219-836-1252
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIRAGOS
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
219-836-1200

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  01022615A , 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: 000000143191 . This is a "ANTHEM BLUE SHIELD IN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com