Provider Demographics
NPI:1437353497
Name:EASTERN INDIANA PODIATRY, P.C.
Entity Type:Organization
Organization Name:EASTERN INDIANA PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-462-1000
Mailing Address - Street 1:744 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1404
Mailing Address - Country:US
Mailing Address - Phone:317-462-1000
Mailing Address - Fax:317-462-5228
Practice Address - Street 1:744 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1404
Practice Address - Country:US
Practice Address - Phone:317-462-1000
Practice Address - Fax:317-462-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000787A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU45081Medicare UPIN
IN252620Medicare PIN