Provider Demographics
NPI:1952356883
Name:EMERGENCY MEDICINE OF INDIANA
Entity type:Organization
Organization Name:EMERGENCY MEDICINE OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-435-7937
Mailing Address - Street 1:PO BOX 11849
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46861-1849
Mailing Address - Country:US
Mailing Address - Phone:260-435-7937
Mailing Address - Fax:260-435-7933
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-7001
Practice Address - Fax:260-407-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCA6307OtherRAIL ROAD MEDICARE
INCM0041OtherRAIL ROAD
IN138420Medicare ID - Type UnspecifiedGROUP NUMBER