1720266406 NPI number — BIO-MEDICAL APPLICATIONS OF INDIANA, INC.

Table of content: MRS. ELLEN MARIE WIRTZ LISW (NPI 1235199282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720266406 NPI number — BIO-MEDICAL APPLICATIONS OF INDIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIO-MEDICAL APPLICATIONS OF INDIANA, 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:
1720266406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 S. WISCONSIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46342-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-947-9289
Provider Business Mailing Address Fax Number:
219-947-9392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 S. WISCONSIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-947-9289
Provider Business Practice Location Address Fax Number:
219-947-9392
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FAWCETT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
781-699-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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