1528054012 NPI number — DR. CATHERINE ELIZABETH BUCKINGHAM PHD HSPP

Table of content: DR. CATHERINE ELIZABETH BUCKINGHAM PHD HSPP (NPI 1528054012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528054012 NPI number — DR. CATHERINE ELIZABETH BUCKINGHAM PHD HSPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKINGHAM
Provider First Name:
CATHERINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD HSPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANK
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528054012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6626 E 75TH STREET
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-2890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-621-7561
Provider Business Mailing Address Fax Number:
317-355-6096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7250 CLEARVISTA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 227
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-621-7804
Provider Business Practice Location Address Fax Number:
317-621-7275
Provider Enumeration Date:
09/21/2005

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: 103T00000X , with the licence number:  20040938A , 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: P01191790 . This is a "RR MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200324030 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01678706 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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