Provider Demographics
NPI:1801941083
Name:MIKE CARPINO FORD MERCURY IN
Entity type:Organization
Organization Name:MIKE CARPINO FORD MERCURY IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-429-2200
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:HWY 160 69 7 JCT
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725
Mailing Address - Country:US
Mailing Address - Phone:620-429-2200
Mailing Address - Fax:620-429-1966
Practice Address - Street 1:HWY 160 69 7 JCT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725
Practice Address - Country:US
Practice Address - Phone:620-429-2200
Practice Address - Fax:620-429-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200376950Medicaid
KS200376950Medicaid