1982765780 NPI number — MISS KATE ELLEN TUTTLE D.C.

Table of content: MISS KATE ELLEN TUTTLE D.C. (NPI 1982765780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982765780 NPI number — MISS KATE ELLEN TUTTLE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUTTLE
Provider First Name:
KATE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1982765780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4625 S EMERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46203-5972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-522-2303
Provider Business Mailing Address Fax Number:
317-522-2304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7015 S KENTUCKY AVE STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46113-9304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-856-4800
Provider Business Practice Location Address Fax Number:
317-856-6215
Provider Enumeration Date:
12/13/2006

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: 111NN1001X , with the licence number:  08002303A , 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: 000000556459 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00470037 . This is a "MEDICARE RAILROAD NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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