Provider Demographics
NPI:1154751279
Name:JOHN W CARTER MD LLC
Entity type:Organization
Organization Name:JOHN W CARTER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-789-4541
Mailing Address - Street 1:349 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320-1705
Mailing Address - Country:US
Mailing Address - Phone:765-789-4541
Mailing Address - Fax:765-789-4547
Practice Address - Street 1:349 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47320-1705
Practice Address - Country:US
Practice Address - Phone:765-789-4541
Practice Address - Fax:765-789-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201206390AMedicaid
IN201206390AMedicaid