Provider Demographics
NPI:1609947571
Name:KEVIN J POWERS
Entity Type:Organization
Organization Name:KEVIN J POWERS
Other - Org Name:KEVIN J POWERS DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-333-4422
Mailing Address - Street 1:PO BOX 1981
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1981
Mailing Address - Country:US
Mailing Address - Phone:812-333-4422
Mailing Address - Fax:812-333-6698
Practice Address - Street 1:1791 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-5029
Practice Address - Country:US
Practice Address - Phone:812-333-4422
Practice Address - Fax:812-333-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200347590AMedicaid
IN480019215OtherTRAVELERS MEDICARE
IN1300330001Medicare NSC
IN480019215OtherTRAVELERS MEDICARE