Special Medicine Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

01029292A Issued in IN

Legal business name

SPECIAL MEDICINE CLINIC

Practice address

1501 Wabash St Ste 303
Michigan City, IN 46360-4355

Phone

(219) 874-8711

Fax

(219) 874-9075

NPI assigned

Jan 30, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Bina Gupta

Title

Office Manager

Phone

(219) 874-8711

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233273600000",
    "number": "1962640821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 WABASH ST STE 303",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463604355",
            "telephone_number": "219-874-8711",
            "fax_number": "219-874-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 WABASH ST STE 303",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463604355",
            "telephone_number": "219-874-8711",
            "fax_number": "219-874-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIAL MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-01-30",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "BINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "219-874-8711",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "01029292A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000111817",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Michigan City, IN
• Providers in Michigan City, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; 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.