1902014301 NPI number — DR. RUSSELL C HARMS D.P.M.

Table of content: DR. RUSSELL C HARMS D.P.M. (NPI 1902014301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902014301 NPI number — DR. RUSSELL C HARMS D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMS
Provider First Name:
RUSSELL
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1902014301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 E NATIONAL AVE
Provider Second Line Business Mailing Address:
SUIT 130
Provider Business Mailing Address City Name:
BRAZIL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47834-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-448-9290
Provider Business Mailing Address Fax Number:
812-448-9296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 E NATIONAL AVE
Provider Second Line Business Practice Location Address:
SUIT 130
Provider Business Practice Location Address City Name:
BRAZIL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47834-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-448-9290
Provider Business Practice Location Address Fax Number:
812-448-9296
Provider Enumeration Date:
05/18/2007

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: 213ES0103X , with the licence number:  41000207-A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 07001065A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000601499 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200910370 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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