1437108289 NPI number — DR. DANIEL ROSS HAYFORD M.D.

Table of content: DR. DANIEL ROSS HAYFORD M.D. (NPI 1437108289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437108289 NPI number — DR. DANIEL ROSS HAYFORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYFORD
Provider First Name:
DANIEL
Provider Middle Name:
ROSS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAYFORD
Provider Other First Name:
DANIEL
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437108289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 BEACHWAY DRIVE, SUITE 210
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:
46224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-387-4219
Provider Business Mailing Address Fax Number:
317-293-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 BEACHWAY DRIVE, SUITE 210
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:
46224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-293-7177
Provider Business Practice Location Address Fax Number:
317-293-3991
Provider Enumeration Date:
05/09/2006

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: 208000000X , with the licence number:  01062065A , 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: 1437108289 . This is a "NPI, INDIVIDUAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 202140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316128614 . This is a "NPI, IIP GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200826760 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000544431 . This is a "ANTHEM, IIP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000482970 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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