1235450867 NPI number — COLEMAN INSTITUTE- INDIANA PETER RICHARD COLEMAN SOLE MBR

Table of content: (NPI 1235450867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235450867 NPI number — COLEMAN INSTITUTE- INDIANA PETER RICHARD COLEMAN SOLE MBR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLEMAN INSTITUTE- INDIANA PETER RICHARD COLEMAN SOLE MBR
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:
1235450867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 WALL ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-288-8410
Provider Business Mailing Address Fax Number:
812-288-8409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 WALL ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-288-8410
Provider Business Practice Location Address Fax Number:
812-288-8409
Provider Enumeration Date:
06/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHIELDS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
804-282-9133

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  02001067A , 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: 1437214731 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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