1710085550 NPI number — DR. JAMES TIMOTHY ALDRIDGE D.O.

Table of content: CATHY WUSTERBARTH (NPI 1750861902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710085550 NPI number — DR. JAMES TIMOTHY ALDRIDGE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALDRIDGE
Provider First Name:
JAMES
Provider Middle Name:
TIMOTHY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALDRIDGE
Provider Other First Name:
TIMOTHY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710085550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46975-8931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-223-2020
Provider Business Mailing Address Fax Number:
574-223-5847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46975-8931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-223-2020
Provider Business Practice Location Address Fax Number:
574-223-5847
Provider Enumeration Date:
09/20/2006

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: 207RC0200X , with the licence number:  02001427 , 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: 100269960B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255439022 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 110207420 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100366380 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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