Provider Demographics
NPI:1902894074
Name:HABIMANA, THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HABIMANA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11460 N MERIDIAN ST
Mailing Address - Street 2:STE. 110
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4408
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:317-614-9655
Practice Address - Street 1:3630 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1616
Practice Address - Country:US
Practice Address - Phone:317-920-8439
Practice Address - Fax:317-614-9655
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1097396367500000X
IN28122164A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000283641OtherANTHEM BLUE SHIELD
430080249OtherRAILROAD MEDICARE
IN200428210Medicaid
KY50012416OtherPASSPORT
KY74005273Medicaid
KY2773493000OtherPASSPORT ADVANTAGE
KY2773493000OtherPASSPORT ADVANTAGE
KY74005273Medicaid