1326360256 NPI number — MUNSTER MEDICAL RESEARCH FOUNDATION, INC.

Table of content: (NPI 1326360256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326360256 NPI number — MUNSTER MEDICAL RESEARCH FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
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:
1326360256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/13/2010
NPI Reactivation Date:
04/28/2010

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 MACARTHUR BLVD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-5512
Provider Business Mailing Address Fax Number:
219-836-7978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-5512
Provider Business Practice Location Address Fax Number:
219-836-7978
Provider Enumeration Date:
02/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FESKO
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
219-836-1600

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200281190 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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