1710993548 NPI number — NANDALAL YEPURI MD CLARKSVILLE LLC

Table of content: (NPI 1710993548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710993548 NPI number — NANDALAL YEPURI MD CLARKSVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANDALAL YEPURI MD CLARKSVILLE 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:
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:
1710993548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 EASTERN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47129-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-284-4437
Provider Business Mailing Address Fax Number:
812-285-0256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 EASTERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47129-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-284-4437
Provider Business Practice Location Address Fax Number:
812-285-0256
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YEPURI
Authorized Official First Name:
NANDALAL
Authorized Official Middle Name:
Authorized Official Title or Position:
MD OWNER
Authorized Official Telephone Number:
812-284-4437

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01027999 , 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: 100075000A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com