Provider Demographics
NPI:1205956646
Name:DANIEL C EBY D.O. PC
Entity type:Organization
Organization Name:DANIEL C EBY D.O. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-482-7441
Mailing Address - Street 1:600 W. 13TH ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1883
Mailing Address - Country:US
Mailing Address - Phone:812-482-7441
Mailing Address - Fax:812-482-7444
Practice Address - Street 1:600 W. 13TH ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1883
Practice Address - Country:US
Practice Address - Phone:812-482-7441
Practice Address - Fax:812-482-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001643A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000332839OtherANTHEM BLUE CROSS
IN200871340AMedicaid
IN000000332839OtherANTHEM BLUE CROSS
IN5160900001Medicare NSC
IN219120Medicare PIN