Basic Information
| Provider Information | |||||||||
| NPI: | 1083697700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDRIDGE | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 HIGHLANDER POINT DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | FLOYDS KNOBS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471199465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129234106 | ||||||||
| FaxNumber: | 8129234100 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HIGHLANDER POINT DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | FLOYDS KNOBS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471199465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129234106 | ||||||||
| FaxNumber: | 8129234100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01041833 | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 100327230A | 05 | IN | MEDICAID |