1518916022 NPI number — GLORIA J KOCHER CRNA

Table of content: GLORIA J KOCHER CRNA (NPI 1518916022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518916022 NPI number — GLORIA J KOCHER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCHER
Provider First Name:
GLORIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1518916022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3033
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-567-2180
Provider Business Mailing Address Fax Number:
317-567-2191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-567-2180
Provider Business Practice Location Address Fax Number:
317-567-2191
Provider Enumeration Date:
05/10/2006

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: 367500000X , with the licence number:  28139326A , 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: 000000479783 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 11573406 . This is a "CAQH NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 9436026 . This is a "PHCS PID NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200176990 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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