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Contact Information

DERMATOLOGY CLINIC OF MUNCIE, INC.
1808 W ROYALE DR
MUNCIE, IN47304-2243
 Phone: 765-288-8188
 Fax: 765-282-7242
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for DERMATOLOGY CLINIC OF MUNCIE, INC.

NPI Number 1477647303
LBN Legal business name DERMATOLOGY CLINIC OF MUNCIE, INC.
Authorized official CHARLES BARTHOLOME - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/03/2006
Last updated 10/18/2007 - About 19 years ago
Identifiers
IN License # 50001481A
IN Medicaid 100105450
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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