1811994486 NPI number — AMERICAN HEALTHCARE DYNAMIC

Table of content: EDWARD JOSEPH LEGARE M.D. (NPI 1528084191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811994486 NPI number — AMERICAN HEALTHCARE DYNAMIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTHCARE DYNAMIC
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:
1811994486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1033 E WALNUT 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:
47714-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-962-0241
Provider Business Mailing Address Fax Number:
812-962-0505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1033 E WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-962-0241
Provider Business Practice Location Address Fax Number:
812-962-0505
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MILDRED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-962-0241

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 000000337900 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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