1649381690 NPI number — RAMESH SHATAGOPAM MD

Table of content: RAMESH SHATAGOPAM MD (NPI 1649381690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649381690 NPI number — RAMESH SHATAGOPAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHATAGOPAM
Provider First Name:
RAMESH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649381690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 S 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47807-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-242-3175
Provider Business Mailing Address Fax Number:
812-242-3543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1429 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-0564
Provider Business Practice Location Address Fax Number:
812-242-3543
Provider Enumeration Date:
08/31/2006

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: 207RC0000X , with the licence number:  01048847A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 36111955 , 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: 0182822 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 471334 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00855812 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00828502 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200374390 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 778240 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00393763 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7690262001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200374390Z , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: N289136 . This is a "HARMONY HEALTH PLAN IND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200374390L , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351904269120 . This is a "CARESOURCE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7789240 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000224022 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060068689 . This is a "RAILROAD MCARE PALAMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200374390A . This is a "MOLINA HEALTHCARE MCAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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