1003000399 NPI number — RECONSTRUCTIVE HAND TO SHOULDER OF INDIANA, LLC

Table of content: (NPI 1003000399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003000399 NPI number — RECONSTRUCTIVE HAND TO SHOULDER OF INDIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECONSTRUCTIVE HAND TO SHOULDER OF INDIANA, 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:
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:
1003000399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13431 OLD MERIDIAN STREET
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-249-2616
Provider Business Mailing Address Fax Number:
317-249-2618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13431 OLD MERIDIAN STREET
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-249-2616
Provider Business Practice Location Address Fax Number:
317-249-2618
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANNUNZIO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
317-249-2616

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , 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: 01063681A . This is a "MEDICAL LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com