NPIMap

Organization Active NPI

Susan Koslow M.D.,Inc

  • Radiology Clinic/Center
  • Terre Haute, IN
National Provider Identifier
1497028989
Registry record updated Dec 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
01042883A Issued in IN
Legal business name
SUSAN KOSLOW M.D.,INC
Practice address
477 E Trailwood Dr
Terre Haute, IN 47802-9606
Phone
(812) 234-4243
Fax
(812) 478-3663
NPI assigned
Feb 15, 2012
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kris Doan
Title
Billing Supervisor
Phone
(812) 234-4243

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 01042883A IN Primary

Addresses

NPPES NPI Registry

Primary practice location

477 E Trailwood Dr
Terre Haute, IN 47802-9606

Mailing address

PO Box 10037
Terre Haute, IN 47801-0037
Phone (812) 234-4243

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
100462130AMedicaidIN
M100067995OtherINMEDICARE PTAN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 18, 2014.

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418860800000",
    "number": "1497028989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10037",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478010037",
            "telephone_number": "812-234-4243",
            "fax_number": "812-478-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 E TRAILWOOD DR",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478029606",
            "telephone_number": "812-234-4243",
            "fax_number": "812-478-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN KOSLOW M.D.,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2014-12-18",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "KRIS",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "812-234-4243"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "IN",
            "license": "01042883A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100462130A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M100067995",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; 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.