1346345287 NPI number — ADAMS PHYSICAL THERAPY SERVICES, INC.

Table of content: (NPI 1346345287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346345287 NPI number — ADAMS PHYSICAL THERAPY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAMS PHYSICAL THERAPY SERVICES, 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:
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:
1346345287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1085
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47371-3185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-726-6828
Provider Business Mailing Address Fax Number:
260-726-2257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47371-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-726-6828
Provider Business Practice Location Address Fax Number:
260-726-2257
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
ROY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
260-726-6828

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05001458A , 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: 2329162 . This is a "OHIO MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200154330C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105382 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000093733 . This is a "ANTHEM BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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