1659716017 NPI number — INDIANA UNIVERSITY SCHOOL OF MEDICINE

Table of content: (NPI 1659716017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659716017 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:
IU/METHODIST FAMILY MEDICINE RESIDENCY
Provider Other Organization Name Type Code:
5
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:
1659716017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 LEXINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-9795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-559-2341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 N SENATE AVE
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:
46202-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-559-2341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GOUDREAU
Authorized Official First Name:
LORA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
RESIDENCY COORDINATOR
Authorized Official Telephone Number:
317-962-5423

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com