Provider Demographics
NPI:1619069606
Name:MCDOWELL, RUTH A (PA-C)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA C
Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-343-6562
Practice Address - Street 1:765 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3101
Practice Address - Country:US
Practice Address - Phone:574-235-7990
Practice Address - Fax:574-847-7201
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004370A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP51860Medicare UPIN
N30180007Medicare PIN