1609866722 NPI number — KEITH M RAMSEY MEDICAL CORP

Table of content: (NPI 1609866722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609866722 NPI number — KEITH M RAMSEY MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEITH M RAMSEY MEDICAL CORP
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:
1609866722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1512 BURR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46406-2369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-944-3933
Provider Business Mailing Address Fax Number:
219-944-2473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7863 BROADWAY STE 244
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-5553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-991-3602
Provider Business Practice Location Address Fax Number:
219-962-5053
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
ORVILLE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
904-503-1132

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  01036485 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 036068254 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100201350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com