1487451639 NPI number — 223 FERDINAND PROFESSIONAL, PC

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 1487451639 NPI number — 223 FERDINAND PROFESSIONAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
223 FERDINAND PROFESSIONAL, 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:
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:
1487451639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 W 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERDINAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47532-9016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-367-1639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 W 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERDINAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47532-9016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-367-1639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2025

Additional Information

Authorized Official

Authorized Official Last Name:
FORSYTH
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PAYOR RELATIONS LEADER
Authorized Official Telephone Number:
812-367-1639

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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