Blue Tree Nutrition
Organization Active NPI Registered Dietitian · Zionsville, IN
NPI 1811518103 · NPPES record last updated Apr 28, 2020
Key facts
- NPI
- 1811518103
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Registered Dietitian 133V00000X
- Legal business name
- BLUE TREE NUTRITION
- Practice address
- 75 E Pine St
Zionsville, IN 46077-1529 - Phone
- (410) 963-4782
- Fax
- (317) 671-7633
- NPI assigned
- Apr 28, 2020
- Organization subpart
- No
Authorized official
- Name
- Mrs. Valerie Lynn Polley, RD
- Title
- Registered Dietitian
- Phone
- (410) 963-4782
Practitioners 1
-
Valerie Lynn Polley, RDN, CD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200629002687 | IN | Part B Supplier - Clinic/Group Practice | 3870915382 |
Receives reassigned benefits from 1 practitioner Practice locations: Zionsville, IN |
National Provider Directory
Locations
75 E Pine St
Zionsville, IN 46077
Phone (410) 963-4782
4582 NW Plaza West Dr
Ste 11
Zionsville, IN 46077
Phone (410) 963-4782
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | Yes |
Addresses
Primary practice location
75 E Pine St
Zionsville, IN 46077-1529
Mailing address
PO Box 73
Carmel, IN 46082-0073
Phone (410) 963-4782
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619321973 | Other | IN | TYPE 1 |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Kalix | Health Information Exchange (HIE) |
Other providers in Zionsville, IN
- Bethany J Geyman DDS Inc
- Sally Estelle Bias
- Roxanne Bielak
- Biotechnics Corp
- Sherrie Bloemendaal
- Richard W Boersma
- Stacia L Bohland
- Amber Boksa
- Taryn Marie Bolton
- Theresa Ann Bonar
All providers in Zionsville, IN · Registered Dietitian in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.