1831185800 NPI number — DR. ERNEST C MIRICH MD

Table of content: DR. ERNEST C MIRICH MD (NPI 1831185800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831185800 NPI number — DR. ERNEST C MIRICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRICH
Provider First Name:
ERNEST
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1831185800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8550 BROADWAY
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-7193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-769-3550
Provider Business Mailing Address Fax Number:
219-769-8604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8550 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-7032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-769-3550
Provider Business Practice Location Address Fax Number:
219-769-8604
Provider Enumeration Date:
09/23/2005

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: 207RC0000X , with the licence number:  01018811 , 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: 000000083040 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 192820H . This is a "MEDICARE PART B" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100377790 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110085078 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 385970A . This is a "MEDICARE PART B" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2210201 . This is a "MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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