Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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 | 207R00000X | Internal Medicine | | 06-004773-1 | INDIANA | No |
| 2 | 261QC0050X | Clinic/Center | Critical Access Hospital | 05005073-1 | INDIANA | No |
| 3 | 261QC0050X | Clinic/Center | Critical Access Hospital | 06-004773-1 | INDIANA | No |
| 4 | 275N00000X | Medicare Defined Swing Bed Unit | | | | No |
| 5 | 282N00000X | General Acute Care Hospital | | 05005073-1 | INDIANA | No |
| 6 | 282N00000X | General Acute Care Hospital | | 06-004773-1 | INDIANA | No |
| 7 | 282NC0060X | General Acute Care Hospital | Critical Access | 05005073-1 | INDIANA | No |
| 8 | 291U00000X | Clinical Medical Laboratory | | 05005073-1 | INDIANA | No |
| 9 | 291U00000X | Clinical Medical Laboratory | | 06-004773-1 | INDIANA | No |
| 10 | 341600000X | Ambulance | | 05005073-1 | INDIANA | No |
| 11 | 341600000X | Ambulance | | 06-004773-1 | INDIANA | No |
| 12 | 341600000X | Ambulance | | 0325 | INDIANA | No |
| 13 | 341600000X | Ambulance | | | | No |
| 14 | 3416L0300X | Ambulance | Land Transport | | | No |
| 15 | 282NC0060X | General Acute Care Hospital | Critical Access | 06-004773-1 | INDIANA | Yes |
