Active NPI
Immediadent of Indiana, PC
Doing business as Immediadent
- Dentist
- Clarksville, IN
National Provider Identifier
1194193078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12010746A
- Legal business name
- IMMEDIADENT OF INDIANA, PC
- Doing business as
- Immediadent
- Practice address
- 1160 E Lewis and Clark Pkwy
Clarksville, IN 47129-7735 - Phone
- (812) 284-4040
- Fax
- (913) 800-6967
- NPI assigned
- Sep 9, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amy Wheeler
- Title
- Credentialing Coordinator
- Phone
- (913) 800-6952
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12010746A | IN | Primary |
Addresses
Primary practice location
1160 E Lewis and Clark Pkwy
Clarksville, IN 47129-7735
Mailing address
PO Box 11568
Overland Park, KS 66207-4268
Phone (913) 800-6952
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200377170 | Medicaid | IN |
Other names 1
- Immediadent
National Provider Directory
National Provider Directory- Tax ID family
- Immediadent of Indiana PC
Other organizations with this tax ID 11
Organizations that report the same tax identification number in the National Provider Directory.
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": "1194193078",
"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": "1160 E LEWIS AND CLARK PKWY",
"city": "CLARKSVILLE",
"state": "IN",
"postal_code": "471297735",
"telephone_number": "812-284-4040",
"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": "WHEELER",
"authorized_official_first_name": "AMY",
"authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
"authorized_official_telephone_number": "913-800-6952"
},
"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 Clarksville, IN
- Darion Hughes
- Kaden Hujo
- Terry Lynn Humphries, APRN, FNP
- Viorletta Chena Hunter-Lawrence, OTR
- Immediadent of Indiana, P.C. (ImmediaDent)
- Indiana Health & Rehabilitation Centers (Clark rehabilitation and Skilled Nursing Center)
- Indiana Sleep Institute, LLC (Indiana Sleep Institute, ISI, Indiana Sleep, Sleep Institute)
- Insight Health Corp. (Southern Regional MRI)
- Patricia Lee Isaacs, M.D.
- Amanda Michele Isgrigg, OTR/L
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.