1316043243 NPI number — TWO INDIANA FOOT, L.L.C.

Table of content: (NPI 1316043243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316043243 NPI number — TWO INDIANA FOOT, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWO INDIANA FOOT, L.L.C.
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:
1316043243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15454
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47716-0454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-475-8900
Provider Business Mailing Address Fax Number:
812-475-0024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2809 LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-475-8900
Provider Business Practice Location Address Fax Number:
812-475-0024
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUPFER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
812-475-8900

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  07000805A , 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: DF1524 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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