Provider Demographics
NPI:1215213053
Name:MCLAUGHLIN, JAMES M (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:M
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5165 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-838-4758
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28200347A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201049640Medicaid
IN000000752215OtherANTHEM PROVIDER NUMBER
IN000000752215OtherANTHEM PROVIDER NUMBER
INM400063336Medicare PIN