1942260864 NPI number — DR. RICHARD A POTTS DO

Table of content: DR. RICHARD A POTTS DO (NPI 1942260864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942260864 NPI number — DR. RICHARD A POTTS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTTS
Provider First Name:
RICHARD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1942260864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 760
Provider Second Line Business Mailing Address:
1314 EAST WALNUT ST
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-254-7310
Provider Business Mailing Address Fax Number:
812-254-8602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 NORTH WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-636-7300
Provider Business Practice Location Address Fax Number:
812-636-8204
Provider Enumeration Date:
03/24/2006

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: 207Q00000X , with the licence number:  02000896A , 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: 000000316823 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CA5604 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00179048 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100158940 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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