1336550383 NPI number — VERVE HEALTH LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336550383 NPI number — VERVE HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERVE HEALTH 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:
VERVE HEALTH AT CELADON CORPORATE
Provider Other Organization Name Type Code:
5
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:
1336550383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 HAVERSTICK RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46240-4308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-573-7600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9503 E 33RD ST
Provider Second Line Business Practice Location Address:
MEDICAL CLINIC
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46235-4207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-972-7000
Provider Business Practice Location Address Fax Number:
317-972-7088
Provider Enumeration Date:
05/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ERB
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-573-7600

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  02002977A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X , with the licence number: 02002977A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332900000X , with the licence number: 02002977A , 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)





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