1417955873 NPI number — BOARD OF COMMISSIONERS OF NEWTON COUNTY

Table of content: (NPI 1417955873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417955873 NPI number — BOARD OF COMMISSIONERS OF NEWTON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF COMMISSIONERS OF NEWTON COUNTY
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:
1417955873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9951 N 100 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE VILLAGE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46349-9317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-663-9866
Provider Business Mailing Address Fax Number:
219-345-2064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9951 N 100 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE VILLAGE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46349-9317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-663-9866
Provider Business Practice Location Address Fax Number:
219-345-2064
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KALIZAE
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
888-663-9866

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0251 , 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: 1417955873 . This is a "GROUP ADMINISTRATORS LTD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 590009787 . This is a "UNITED HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100287780A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000189146 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100287780 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417955873 . This is a "CONTINENTAL GEN INS CO IN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 17148 . This is a "ARNETT HMO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000189146 . This is a "BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P62949 . This is a "BLUE CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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