1841256021 NPI number — MRS. BETTYE JO E RAWLS LLOYD M.D.

Table of content: MRS. BETTYE JO E RAWLS LLOYD M.D. (NPI 1841256021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841256021 NPI number — MRS. BETTYE JO E RAWLS LLOYD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAWLS LLOYD
Provider First Name:
BETTYE JO
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAWLS LLOYD
Provider Other First Name:
BETTYE JO
Provider Other Middle Name:
ELVAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841256021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11455 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-1624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-846-4223
Provider Business Mailing Address Fax Number:
317-846-6063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N SENATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 620
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-926-6699
Provider Business Practice Location Address Fax Number:
317-921-1723
Provider Enumeration Date:
04/25/2006

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: 207W00000X , with the licence number:  01032373A , 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: 100068150 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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