1902075062 NPI number — ANCHOR HEALTH SYSTEMS, INC.

Table of content: (NPI 1902075062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902075062 NPI number — ANCHOR HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCHOR HEALTH SYSTEMS, INC.
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:
1902075062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 SILHAVY RD.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VALPARAISO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46383-9513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-662-3500
Provider Business Mailing Address Fax Number:
219-246-2544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 SILHAVY RD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VALPARAISO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46383-9513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-662-3500
Provider Business Practice Location Address Fax Number:
219-246-2544
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-662-3500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  070053361 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100264430A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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