1467674648 NPI number — HEALTHCARE CENTERS OF INDIANA, LLC

Table of content: (NPI 1467674648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467674648 NPI number — HEALTHCARE CENTERS OF INDIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE CENTERS OF INDIANA, LLC
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:
1467674648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GLEED AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST AURORA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14052-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-652-2820
Provider Business Mailing Address Fax Number:
171-652-2296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 CROSS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47250-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-273-4640
Provider Business Practice Location Address Fax Number:
812-273-2925
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELDMAN
Authorized Official First Name:
JOY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
716-805-1474

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05000116-1 , 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: 100266330B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com