1437216637 NPI number — DR. JINGER ATTEBERRY-BENNETT PH.D., HSPP

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 1437216637 NPI number — DR. JINGER ATTEBERRY-BENNETT PH.D., HSPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATTEBERRY-BENNETT
Provider First Name:
JINGER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., HSPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ATTEBERRY
Provider Other First Name:
JINGER
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D. HSPP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437216637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10291 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46290-1076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-582-1203
Provider Business Mailing Address Fax Number:
317-853-1314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10293 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-582-1203
Provider Business Practice Location Address Fax Number:
317-853-1314
Provider Enumeration Date:
01/03/2007

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: 103TC0700X , with the licence number:  20040292A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 20040292A , 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: 100120710A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 063867 . This is a "VALUE OPTIONS I.D. NO." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000182361 . This is a "ANTHEM PROVIDER I.D. NO." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000182359 . This is a "ANTHEM PROVIDER I.D. NO." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 10022395 . This is a "ENCORE PPO ONE I.D." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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