1932456928 NPI number — PLANNED PARENTHOOD OF INDIANA AVON

Table of content: (NPI 1932456928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932456928 NPI number — PLANNED PARENTHOOD OF INDIANA AVON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANNED PARENTHOOD OF INDIANA AVON
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:
1932456928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S. MERIDIAN ST.
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-637-4343
Provider Business Mailing Address Fax Number:
317-637-4344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8102 KINGSTON ST.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-6909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-272-2042
Provider Business Practice Location Address Fax Number:
317-272-0601
Provider Enumeration Date:
08/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OVERHOLT
Authorized Official First Name:
SUZANNAH
Authorized Official Middle Name:
WILSON
Authorized Official Title or Position:
VP, FINANCE & ADMINISTRATION
Authorized Official Telephone Number:
317-637-4166

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X , with the licence number:  01041899A , 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: 100326600 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200295610 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".