Provider Demographics
NPI:1255508602
Name:NANCY W. GRIFFITH, M.D.
Entity Type:Organization
Organization Name:NANCY W. GRIFFITH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-521-3161
Mailing Address - Street 1:1516 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4355
Mailing Address - Country:US
Mailing Address - Phone:765-521-3161
Mailing Address - Fax:765-521-2635
Practice Address - Street 1:1516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4355
Practice Address - Country:US
Practice Address - Phone:765-521-3161
Practice Address - Fax:765-521-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027773A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200459450AMedicaid
IN100134800Medicaid
ININ1563Medicare PIN
IN100134800Medicaid