SOUTHEASTERN INDIANA GASTROENTEROLOGY (NPI# 1457332413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457332413 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN INDIANA GASTROENTEROLOGY |
| Practice Address |
2630 22nd St Columbus IN 47201-3702 |
| Practice Telephone | 8123728680 |
| Practice Fax Number | 8123729265 |
| Mailing Telephone | 8123728680 |
| Mailing Fax Number | 8123729265 |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2020-08-22 |
| NPI Deactivation Date | 03/07/2006 |
| NPI Reactivation Date | 2006-12-20 |
| Authorized Official Name | DIANE COLE (PATIENT ACCOUNT REPRESENTATIVE) |
| Authorized Official Telephone | 8123728680 |
| Authorized Official Credential | BILLING OFFICE |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 01033813A | IN | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM | 000000317541 | 01 |
| IN | SIHO PROVIDER NUMBER | 050176P | 01 |
| IN | ICHIA PROVIDER NUMBER | 000000317541 | 01 |
| Street Address |
2630 22ND ST |
| City | COLUMBUS |
| State | IN |
| Zip Code | 47201-3702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245874296 | Amber Rose James | Nurse Practitioner | 2630 22nd St, Columbus, IN 47201-3702 | 2019-11-03 |
| 1982265146 | Sharen Marie Waters | Counselor | 2630 22nd St, Columbus, IN 47201-3702 | 2019-06-27 |
| 1861628661 | Patrick Barrett | Internal Medicine | 2630 22nd St, Columbus, IN 47201-3702 | 2009-06-08 |
| 1760591648 | Kevin Terrell | Emergency Medicine | 2630 22nd St, Columbus, IN 47201 | 2006-08-30 |
| 1427094192 | Geoffrey S Raymer | Internal Medicine | 2630 22nd St, Columbus, IN 47201-3702 | 2006-06-21 |
| 1700853942 | Lora Fathauer | Internal Medicine | 2630 22nd St, Columbus, IN 47201-3702 | 2006-03-07 |
| 1508830373 | Stephen R Stouder | Internal Medicine | 2630 22nd St, Columbus, IN 47201-3702 | 2006-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699389569 | Ryanne Nicole Slavens | Speech-Language Pathologist | 1974 Glenmoor Drive, Columbus, IN 47201 | 2020-09-08 |
| 1023670759 | Alisha Nicole Scoville | Counselor | 2630 22nd Street, Columbus, IN 47201 | 2019-07-02 |
| 1467964718 | Columbus Radiology Physicians LLC | Radiology | 2400 E. 17th Street, Columbus, IN 47201 | 2017-10-26 |
| 1790148849 | Gabriel Woon | Specialist | 913 25th St., Columbus, IN 47201 | 2016-04-05 |
| 1144680604 | Forefront Dermatology, S.c. | Dermatology | 244 Westwood Blvd, Columbus, IN 47201 | 2016-02-26 |
| 1871832550 | Jennifer Lynn Grant | Nurse Practitioner | 836 Jackson St., Columbus, IN 47201 | 2013-01-31 |
| 1235404526 | Eric Philip Tannenbaum | Orthopaedic Surgery | 940 N Marr Rd Ste C, Columbus, IN 47201 | 2012-03-20 |
| 1881994176 | Terri Ann Brewer | Social Worker | 12000 W. Moores Vineyard Rd, Columbus, IN 47201 | 2010-11-02 |
| 1255654620 | The Kane Group LLC | Durable Medical Equipment & Medical Supplies | 927 Fourth Street, Columbus, IN 47201 | 2010-03-12 |
| 1023243771 | Allison K Royer | Otolaryngology | 2326 18th Street, Suite 230, Columbus, IN 47201 | 2009-05-26 |
| Find all providers in zip 47201 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891327755 | Dejuan Julius Nelson | Specialist | 4937 Mcallister Ave, Columbus, OH 43227-1447 | 2020-02-09 |
| 1306481676 | Big Heads Barber Salon | Specialist | 6161 Busch Blvd Ste 56, Columbus, OH 43229-2548 | 2019-11-11 |
| 1538723945 | Nakia Frazier | Specialist | 4913 Festival St, Columbus, GA 31907-6065 | 2019-05-01 |
| 1033772868 | Kimberly Gore Salon Inc | Specialist | 2534 Wynnton Rd Ste B, Columbus, GA 31906-2180 | 2019-04-17 |
| 1184108375 | Crystal Denise Allen | Specialist | 3029 Cleveland Ave, Columbus, OH 43224-4421 | 2018-09-24 |
| 1770074445 | Robert Tavani | Specialist | 1203 E Broad St, Columbus, OH 43205-1404 | 2018-05-29 |
| 1689191991 | Columbus Tutoring Services, LLC | Specialist | 2700 E Main St Ste 211, Columbus, OH 43209-2536 | 2017-08-28 |
| 1265985352 | Tim Jones | Specialist | 1527 Eastmeadow Pl, Columbus, OH 43235-7535 | 2016-07-26 |
| 1790148849 | Gabriel Woon | Specialist | 913 25th St., Columbus, IN 47201 | 2016-04-05 |
| 1487059606 | Wilbert Herschel Turner IIi | Specialist | 1160 Steelwood Rd, Columbus, OH 43212-1356 | 2014-10-30 |
| Find all providers in COLUMBUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.