Provider Demographics
NPI:1922287531
Name:MARK S. SOUDER, M.D.
Entity Type:Organization
Organization Name:MARK S. SOUDER, M.D.
Other - Org Name:COMPREHENSIVE MEDICAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SOUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-925-0305
Mailing Address - Street 1:1310 E 7TH ST
Mailing Address - Street 2:STE J
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 E 7TH ST
Practice Address - Street 2:STE J
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2534
Practice Address - Country:US
Practice Address - Phone:260-925-0305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200409320AMedicaid
INCB6817OtherMEDICARE RR
INCB6817OtherMEDICARE RR
IN200409320AMedicaid