1679035232 NPI number — SUMMIT BHC HENRYVILLLE

Table of content: (NPI 1679035232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679035232 NPI number — SUMMIT BHC HENRYVILLLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT BHC HENRYVILLLE
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:
6
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:
1679035232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
389 NICHOL MILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-4882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-716-4923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E CROSSING BLVD
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:
47802-5316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-898-5100
Provider Business Practice Location Address Fax Number:
812-898-5150
Provider Enumeration Date:
04/03/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
615-716-4924

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300052718 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300035047 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com