1861607715 NPI number — VINCENT P. VECERA

Table of content: (NPI 1861607715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861607715 NPI number — VINCENT P. VECERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT P. VECERA
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:
1861607715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E MAIN ST
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47374-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-966-1180
Provider Business Mailing Address Fax Number:
765-966-4626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E MAIN ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-966-1180
Provider Business Practice Location Address Fax Number:
765-966-4626
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VECERA
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
765-966-1180

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  20050003A , 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: 000000189142 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100425720 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060245000 . This is a "MAGELLAN HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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