Active NPI
Edmundo Noel Tan, MD
- Pediatrics Physician
- Bedford, IN
National Provider Identifier
1376559930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 01031283A
- Practice address
- 2900 16TH St
Bedford, IN 47421-3510 - Phone
- (812) 279-3567
- Fax
- (812) 275-1344
- NPI assigned
- Aug 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01031283A | IN | Primary |
Addresses
Primary practice location
2900 16TH St
Bedford, IN 47421-3510
Mailing address
2900 16TH St
Bedford, IN 47421-3510
Phone (812) 279-3567
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01031283A | IN | MD | Pediatrics Physician |
Interoperability endpoints
- etan@yourcarecommunity.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376559930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 16TH ST",
"city": "BEDFORD",
"state": "IN",
"postal_code": "474213510",
"telephone_number": "812-279-3567",
"fax_number": "812-275-1344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 16TH ST",
"city": "BEDFORD",
"state": "IN",
"postal_code": "474213510",
"telephone_number": "812-279-3567",
"fax_number": "812-275-1344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "EDMUNDO",
"middle_name": "NOEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01031283A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, IN
- Amanda Stroud
- Clay W. Stuckey, D.D.S.
- Brandee Starr Sullivan, NURSE PRACTITIONER
- Casey Michelle Summers
- Mallory Swanson, MSW, LCSW
- Kyra Dee Tatman, NP
- Erin M Taylor, DNP
- Ten Broeck Tennessee Physicians Group Inc (Senior Renewal Center: Dunn)
- The Atrium Dental Center, P.C.
- The Bone and Joint Center of Southern Indiana P.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.