1316054299 NPI number — DR. JAMES C MEADE DPM

Table of content: DR. JAMES C MEADE DPM (NPI 1316054299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316054299 NPI number — DR. JAMES C MEADE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADE
Provider First Name:
JAMES
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1316054299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6916 W JOHNSON RD
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:
46350-8247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-874-2939
Provider Business Mailing Address Fax Number:
219-874-5922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6916 W JOHNSON RD
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:
46350-8247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-874-2939
Provider Business Practice Location Address Fax Number:
219-874-5922
Provider Enumeration Date:
08/24/2006

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: 213ES0103X , with the licence number:  07000785A , 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: 1089370002 . This is a "DMERC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100148090 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC4485 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 480020342 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1089370001 . This is a "DMERC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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