DAVE CURTIS PHONDO - NPI NUMBER 1942564786

Summary

Provider Name: DAVE CURTIS PHONDO

NPI Number: 1942564786

Clasification: Private Vehicle (347C00000X)

Address:
1805 REVERE PL
CARMEL, IN
ZIP 46032

Phone Number: (317) 853-6633



Detailed Information

Dave Curtis Phondo is a private vehicle in Carmel, IN. The provider is an individual paid to provide non-emergency transportation using their privately owned/leased vehicle. The assigned NPI number for this provider is 1942564786 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

1805 REVERE PL
CARMEL, IN
ZIP 46032-937
Phone: (317) 853-6633

The enumeration date for this NPI number is 6/26/2012 and was last updated on 6/26/2012.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 347C00000X Private Vehicle No
2 347C00000X Private Vehicle 347C00000X IN Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1942564786 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
2 Entity Type Code 1 The country code in the location address of the provider being identified.
3 Provider Last Name Legal Name PHONDO The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name DAVE The last name of the provider. If the provider is an individual, this is the legal name.
5 Provider Middle Name CURTIS The middle name of the provider, if the provider is an individual.
6 Provider Name Suffix Text SR. The name suffix of the provider if the provider is an individual. The name suffix is a ‘‘generation-related’’ suffix, such as Jr., Sr., II, III, IV, or V.
7 Provider First Line Business Practice Location Address 1805 REVERE PL The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider Business Practice Location Address City Name CARMEL The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address State Name IN The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
10 Provider Business Practice Location Address Postal Code 460322937 The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
11 Provider Business Practice Location Address Country Code If outside U S US The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Telephone Number 3178536633 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
13 Provider Enumeration Date 6/26/2012 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 6/26/2012 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
15 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
16 Healthcare Provider Taxonomy Code 1 347C00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
17 Healthcare Provider Primary Taxonomy Switch 1 N
18 Healthcare Provider Taxonomy Code 2 347C00000X
19 Provider License Number 2 347C00000X The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 2 IN The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 2 Y
22 Is Sole Proprietor Y


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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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