1962544627 NPI number — ROMELLE A BELMONTE, MD, LLC

Table of content: (NPI 1962544627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962544627 NPI number — ROMELLE A BELMONTE, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMELLE A BELMONTE, MD, LLC
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:
1962544627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15711
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47716-0711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-402-4790
Provider Business Mailing Address Fax Number:
812-402-4794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 W COLUMBIA ST
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47710-1782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-402-4790
Provider Business Practice Location Address Fax Number:
812-402-4794
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELMONTE
Authorized Official First Name:
ROMELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-402-4790

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01044467A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 31177 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 01044467A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0200X , with the licence number: 31177 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000499139 . This is a "BCBS PROVIDER PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200071730B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF4494 . This is a "MEDICARE RR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 64882129 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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