1568618999 NPI number — INDIANA UNIVERSITY SCHOOL OF MEDICINE

Table of content: (NPI 1568618999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568618999 NPI number — INDIANA UNIVERSITY SCHOOL OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568618999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4709 EAGLES WATCH DR
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:
46254-9536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-757-6676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 BARNHILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-274-7139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MORENO-PONTE
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
IGNACIO
Authorized Official Title or Position:
GENERAL SURGERY RESIDENT
Authorized Official Telephone Number:
317-362-5518

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  11014403A , 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: 11014403A . This is a "MEDICAL RESIDENCY PERMIT" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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