1710282439 NPI number — UNITY HEALTHCARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710282439 NPI number — UNITY HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY HEALTHCARE, LLC
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:
1710282439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47903-4699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-449-2732
Provider Business Mailing Address Fax Number:
765-449-1196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3738 LANDMARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-6633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-807-2780
Provider Business Practice Location Address Fax Number:
765-807-2781
Provider Enumeration Date:
01/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
765-446-5417

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , 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: 200476110 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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