1538131115 NPI number — DR. JEFFREY DAVID ORCUTT AU.D.

Table of content: DR. JEFFREY DAVID ORCUTT AU.D. (NPI 1538131115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538131115 NPI number — DR. JEFFREY DAVID ORCUTT AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORCUTT
Provider First Name:
JEFFREY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.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:
1538131115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18000 RIVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOBLESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46062-8329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-774-7811
Provider Business Mailing Address Fax Number:
317-776-4557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18000 RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46062-8329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-773-6579
Provider Business Practice Location Address Fax Number:
317-776-4557
Provider Enumeration Date:
02/07/2006

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: 231H00000X , with the licence number:  23002319A , 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: 000000324103 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200452900 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000324102 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000352573 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000314709 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000324101 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000324104 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000324100 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P01027067 . This is a "MEDICARE RR PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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