1467639567 NPI number — INDIANA SPINE GROUP, PC

Table of content: (NPI 1467639567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467639567 NPI number — INDIANA SPINE GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA SPINE GROUP, PC
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:
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:
1467639567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13225 N MERIDIAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-5480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-228-7000
Provider Business Mailing Address Fax Number:
317-228-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13914 SOUTHEASTERN PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-228-7000
Provider Business Practice Location Address Fax Number:
317-228-2321
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SIKAND
Authorized Official First Name:
HARDEEP
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
317-228-7000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ8084 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 366735000 . This is a "US POSTAL SERVICE WORKERS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 366735000 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4643907 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000214063 . This is a "ANTHEM GROUP NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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