Provider Demographics
NPI:1437315132
Name:NORTHERN SURGICAL CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:NORTHERN SURGICAL CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:DELUMPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:765-675-3872
Mailing Address - Street 1:401 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-9596
Mailing Address - Country:US
Mailing Address - Phone:765-675-3872
Mailing Address - Fax:765-675-8472
Practice Address - Street 1:401 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-9596
Practice Address - Country:US
Practice Address - Phone:765-675-3872
Practice Address - Fax:765-675-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044980A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200105790AMedicaid
IN200105790AMedicaid