1528082658 NPI number — KURT M TERRELL M.D.

Table of content: KURT M TERRELL M.D. (NPI 1528082658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528082658 NPI number — KURT M TERRELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRELL
Provider First Name:
KURT
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1528082658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 E 96TH ST STE 200
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:
46240-3797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOHNSON MEMORIAL HEALTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
1125 W JEFFERSON STREET
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-736-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006

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: 207L00000X , with the licence number:  01050084 , 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: 200371540 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".