1487671251 NPI number — SURGICAL ASSOCIATES OF MADISON COUNTY, 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 1487671251 NPI number — SURGICAL ASSOCIATES OF MADISON COUNTY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES OF MADISON COUNTY, 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:
1487671251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 N GRANVILLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47303-2110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-213-3238
Provider Business Mailing Address Fax Number:
765-284-2434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 MEDICAL ARTS BLVD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46011-3461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-298-4140
Provider Business Practice Location Address Fax Number:
765-284-2434
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCURDY
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
BENJAMIN
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
765-298-4140

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200236860 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200039730A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200442460A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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