Provider Demographics
NPI:1750350526
Name:CARNEY, JOHN RICHARD (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:CARNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2477
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002282A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9274783OtherPHCS PID NUMBER
IN000000202495OtherANTHEM PROVIDER NUMBER
IN200334450Medicaid
IN10824872OtherCAQH NUMBER
IN815460QQQMedicare PIN
IN142080YYMedicare PIN
IN200334450Medicaid
IN870630SMedicare PIN
IN300123190Medicare PIN
IN185510OOMedicare PIN
IN000000202495OtherANTHEM PROVIDER NUMBER
IN815510UUMedicare PIN
IN815520WWMedicare PIN
IN815500AAAAMedicare PIN