1487843801 NPI number — DR. MARTIN THOMAS BARCO III

Table of content: DR. MARTIN THOMAS BARCO III (NPI 1487843801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487843801 NPI number — DR. MARTIN THOMAS BARCO III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARCO
Provider First Name:
MARTIN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
Provider Gender Code:
M

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:
1487843801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 WISHARD BLVD # R4201
Provider Second Line Business Mailing Address:
DEPARTMENT OF ORAL SURGERY AND HOSPITAL DENTISTRY IUPUI
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-2872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-312-0890
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47404-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-332-8290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  120011246A , 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: 200978410 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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