1831466085 NPI number — DON F. STALLMAN MD

Table of content: (NPI 1831466085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831466085 NPI number — DON F. STALLMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DON F. STALLMAN MD
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:
1831466085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 E WAYNE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENDALLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46755-1459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-347-2854
Provider Business Mailing Address Fax Number:
260-347-3863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 E WAYNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDALLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46755-1459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-347-2854
Provider Business Practice Location Address Fax Number:
260-347-3863
Provider Enumeration Date:
11/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STALLMAN
Authorized Official First Name:
DON
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
260-347-2854

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  01027870 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 01027870 , 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: 108772 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00011664 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4105386 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100190840 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1892 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000000258973 . This is a "ANTHEM BC-REG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000000282834 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 312507650 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com