1336180173 NPI number — BELTWAY SURGERY CENTERS LLC

Table of content: (NPI 1336180173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336180173 NPI number — BELTWAY SURGERY CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELTWAY SURGERY CENTERS LLC
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:
1336180173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 PENNSYLVANIA PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46280-1379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-817-1126
Provider Business Mailing Address Fax Number:
317-817-1059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 PENNSYLVANIA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46280-1379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-817-1126
Provider Business Practice Location Address Fax Number:
317-817-1059
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ETCHISON
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, ASC CLINICAL OPERATIONS
Authorized Official Telephone Number:
317-817-1095

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  060022771 , 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: 36858 . This is a "MPLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 414184 . This is a "HEALTHLINK" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200255810A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: C65260 . This is a "C5HC5" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200255810A . This is a "HCI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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