Individual provider Active NPI

Eduardo Emmanuel Jr Endaya Tacolod

  • Registered Nurse
  • Indianapolis, IN
National Provider Identifier
1366950552
Registry record updated Jan 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
656933 Issued in NY
Practice address
7345 Woodland Dr Ste D
Indianapolis, IN 46278-1737
Phone
(317) 286-2885
Fax
(317) 536-3097
NPI assigned
Jan 22, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 656933 NY Primary

Addresses

Primary practice location

7345 Woodland Dr Ste D
Indianapolis, IN 46278-1737

Mailing address

7345 Woodland Dr Ste D
Indianapolis, IN 46278-1737
Phone (317) 286-2885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
656933NYMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516579200000",
    "number": "1366950552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7345 WOODLAND DR STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462781737",
            "telephone_number": "317-286-2885",
            "fax_number": "317-536-3097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7345 WOODLAND DR STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462781737",
            "telephone_number": "317-286-2885",
            "fax_number": "317-536-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACOLOD",
        "first_name": "EDUARDO EMMANUEL JR",
        "middle_name": "ENDAYA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-22",
        "last_updated": "2018-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "656933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; 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.