1700816683 NPI number — ECHO COMMUNITY HEALTH CARE, INC.

Table of content: (NPI 1700816683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700816683 NPI number — ECHO COMMUNITY HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECHO COMMUNITY HEALTH CARE, INC.
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:
1700816683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 MULBERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47713-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-421-7489
Provider Business Mailing Address Fax Number:
812-421-7497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 JOHN STREET
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47713-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-436-0224
Provider Business Practice Location Address Fax Number:
812-436-0230
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRADER-MCMILLEN
Authorized Official First Name:
SANDEE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
812-421-7489

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  261QF0400X , 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: 200079040C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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