Provider Demographics
NPI:1700933744
Name:DERMATHERIC LLC
Entity Type:Organization
Organization Name:DERMATHERIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:765-827-4000
Mailing Address - Street 1:748 NORTHSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2583
Mailing Address - Country:US
Mailing Address - Phone:765-827-4000
Mailing Address - Fax:765-827-4000
Practice Address - Street 1:822 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4331
Practice Address - Country:US
Practice Address - Phone:765-965-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1669452959OtherINDIVIDUAL NPI #
IN233150Medicare PIN
IN1669452959OtherINDIVIDUAL NPI #