1902975881 NPI number — FAMILY PRACTICE ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902975881 NPI number — FAMILY PRACTICE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PRACTICE ASSOCIATES
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:
1902975881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1314 E 7TH ST
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46706-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-925-0403
Provider Business Mailing Address Fax Number:
260-925-9545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 E 7TH ST
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46706-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-925-0403
Provider Business Practice Location Address Fax Number:
260-925-9545
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
260-925-0403

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01034432 , 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)





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