Provider Demographics
NPI:1619993573
Name:HOUSE, BEVE P III (MD)
Entity Type:Individual
Prefix:
First Name:BEVE
Middle Name:P
Last Name:HOUSE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6276
Mailing Address - Street 2:DPT 20
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6276
Mailing Address - Country:US
Mailing Address - Phone:317-802-3143
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:1500 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3027
Practice Address - Country:US
Practice Address - Phone:317-802-3143
Practice Address - Fax:317-870-0499
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041579207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200051450Medicaid
IN115450008Medicare PIN
INM400069572Medicare PIN