1194724641 NPI number — DOUGLAS A BRUNS DO

Table of content: DOUGLAS A BRUNS DO (NPI 1194724641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194724641 NPI number — DOUGLAS A BRUNS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNS
Provider First Name:
DOUGLAS
Provider Middle Name:
A
Provider Name Prefix Text:
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:
1194724641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47006-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-933-5441
Provider Business Mailing Address Fax Number:
812-933-5446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 MITCHELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47006-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-933-5018
Provider Business Practice Location Address Fax Number:
812-933-5472
Provider Enumeration Date:
07/18/2005

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: 2085R0202X , with the licence number:  34006256B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 940080125 . This is a "MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200265810 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0194981 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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