1265611933 NPI number — MR. ANDREW THOMAS ZEILBECK MASP

Table of content: MR. ANDREW THOMAS ZEILBECK MASP (NPI 1265611933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265611933 NPI number — MR. ANDREW THOMAS ZEILBECK MASP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEILBECK
Provider First Name:
ANDREW
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MASP
Provider Gender Code:
M

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:
1265611933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 PATTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PORTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46350-3160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-575-1437
Provider Business Mailing Address Fax Number:
219-362-1586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 PATTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46350-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-575-1437
Provider Business Practice Location Address Fax Number:
219-362-1586
Provider Enumeration Date:
10/30/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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