1285660902 NPI number — ANN U MADDEN OD

Table of content: ANN U MADDEN OD (NPI 1285660902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285660902 NPI number — ANN U MADDEN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDEN
Provider First Name:
ANN
Provider Middle Name:
U
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1285660902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2251 DUBOIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46580-3212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-269-2777
Provider Business Mailing Address Fax Number:
574-371-4697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2251 DUBOIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46580-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-269-2777
Provider Business Practice Location Address Fax Number:
574-371-4697
Provider Enumeration Date:
06/24/2006

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: 152W00000X , with the licence number:  18003072A , 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: 201027750 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00442910 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com