1356389902 NPI number — MAJOR HOSPITAL

Table of content: (NPI 1356389902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356389902 NPI number — MAJOR HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAJOR HOSPITAL
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:
1356389902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3895 S KEYSTONE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46227-3540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-787-5364
Provider Business Mailing Address Fax Number:
765-788-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3895 S KEYSTONE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46227-3540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-787-5364
Provider Business Practice Location Address Fax Number:
317-788-3962
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORNER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
317-398-5252

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05-000537-3 , 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: 000000476407 . This is a "ANTHEM OT" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000476408 . This is a "ANTHEM PT" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000381427 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100267270C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000476409 . This is a "ANTHEM ST" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 5585000001 . This is a "DMERC REGION B SUPPLIER#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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