1285234237 NPI number — VB MEDICAL GROUP

Table of content: (NPI 1285234237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285234237 NPI number — VB MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VB MEDICAL GROUP
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:
1285234237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 QUARTERMASTER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-920-3005
Provider Business Mailing Address Fax Number:
866-554-1805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 QUARTERMASTER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-920-3005
Provider Business Practice Location Address Fax Number:
866-554-1805
Provider Enumeration Date:
10/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & MANAGER
Authorized Official Telephone Number:
812-920-3005

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300049921 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com