Provider Demographics
NPI:1497709950
Name:MBWOUDE, INC.
Entity Type:Organization
Organization Name:MBWOUDE, INC.
Other - Org Name:APT PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OFFICE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-864-3300
Mailing Address - Street 1:1100 JOLIET ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1996
Mailing Address - Country:US
Mailing Address - Phone:219-864-3300
Mailing Address - Fax:219-864-2569
Practice Address - Street 1:1100 JOLIET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1996
Practice Address - Country:US
Practice Address - Phone:219-864-3300
Practice Address - Fax:219-864-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN164465OtherINDIANA DEPT OF HEALTH
IN000000324507OtherANTHEM BCBS
IN0586236OtherCIGNA
IN90001153OtherBC OF ILLINOIS
IN5195522OtherAETNA
IN5195522OtherAETNA
IN0586236OtherCIGNA
IN000000324507OtherANTHEM BCBS