1467673749 NPI number — INDIANA CARDIAC & VASCULAR CONSULTANTS

Table of content: (NPI 1467673749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467673749 NPI number — INDIANA CARDIAC & VASCULAR CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA CARDIAC & VASCULAR CONSULTANTS
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:
1467673749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
389 E MORGAN ST
Provider Second Line Business Mailing Address:
SUITE #3
Provider Business Mailing Address City Name:
MARTINSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46151-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-342-1680
Provider Business Mailing Address Fax Number:
765-342-1683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
389 E MORGAN ST
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46151-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-342-1680
Provider Business Practice Location Address Fax Number:
765-342-1683
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOMARI
Authorized Official First Name:
H.
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-887-7700

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01035232 , 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: 100120900 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com