Provider Demographics
NPI:1790743367
Name:PERKINS VAN NATTA PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:PERKINS VAN NATTA PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-663-7247
Mailing Address - Street 1:170 W 106TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1004
Mailing Address - Country:US
Mailing Address - Phone:317-575-0330
Mailing Address - Fax:317-846-5719
Practice Address - Street 1:170 W 106TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1004
Practice Address - Country:US
Practice Address - Phone:317-575-0330
Practice Address - Fax:317-846-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN117890Medicare ID - Type Unspecified
IN100444190BMedicaid