1235245028 NPI number — WALTER G WARREN DPM, PC

Table of content: (NPI 1235245028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235245028 NPI number — WALTER G WARREN DPM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTER G WARREN DPM, PC
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:
6
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:
1235245028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEYMOUR
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47274-0707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-524-3338
Provider Business Mailing Address Fax Number:
812-524-3337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1239 E 4TH STREET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEYMOUR
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47274-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-524-3338
Provider Business Practice Location Address Fax Number:
812-524-3337
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-524-3338

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  07000678 , 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: 380042P . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0369030001 . This is a "DMERC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000092305 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 480024209 . This is a "PALMETTO GBA RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100140790A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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