1386934982 NPI number — HEIDI J COHER PA

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 1386934982 NPI number — HEIDI J COHER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHER
Provider First Name:
HEIDI
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHLENSKY
Provider Other First Name:
HEIDI
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386934982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8607 E US HIGHWAY 36 # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46123-7960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-208-3866
Provider Business Mailing Address Fax Number:
317-208-3867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8607 E US HIGHWAY 36 # 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-7960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-208-3866
Provider Business Practice Location Address Fax Number:
317-208-3867
Provider Enumeration Date:
04/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  10001266A , 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: 10001266 . This is a "PA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P01291686 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 300005200 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99046364A . This is a "INDIANA MEDICAL LICENSING AGENCY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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