NPIMap

Organization Active NPI

Immediadent of Indiana, PC

  • Dentist
  • New Albany, IN
National Provider Identifier
1124496005
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12010746A Issued in IN
Legal business name
IMMEDIADENT OF INDIANA, PC
Practice address
360 New Albany PLZ
New Albany, IN 47150-4654
Phone
(812) 945-4040
Fax
(913) 800-6967
NPI assigned
Sep 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Frank, DDS
Title
PC President
Phone
(812) 284-6328

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12010746A IN Primary

Addresses

Primary practice location

360 New Albany PLZ
New Albany, IN 47150-4654

Mailing address

PO Box 11568
Overland Park, KS 66207-4268
Phone (913) 800-6952

Other identifiers 1

IdentifierTypeStateIssuer
200377170MedicaidIN

Other names 1

  • Immediadent Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Immediadent of Indiana PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

360 New Albany Plz
New Albany, IN 47150
Phone (812) 250-4535

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1124496005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11568",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662074268",
            "telephone_number": "913-800-6952",
            "fax_number": "913-800-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 NEW ALBANY PLZ",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471504654",
            "telephone_number": "812-945-4040",
            "fax_number": "913-800-6967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMEDIADENT OF INDIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "FRANK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PC PRESIDENT",
        "authorized_official_telephone_number": "812-284-6328",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010746A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200377170",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immediadent",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Albany, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.