Provider Demographics
NPI:1710166343
Name:PMP ASSOCIATES P C
Entity Type:Organization
Organization Name:PMP ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PROMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-972-3300
Mailing Address - Street 1:8219 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1131
Mailing Address - Country:US
Mailing Address - Phone:219-972-3300
Mailing Address - Fax:219-972-3400
Practice Address - Street 1:8219 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1131
Practice Address - Country:US
Practice Address - Phone:219-972-3300
Practice Address - Fax:219-972-3400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PMP ASSOCIATES P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-31
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028868A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100158410AMedicaid