1063552529 NPI number — FRANK DANIEL MONGIARDO M.D. P.S.C

Table of content: (NPI 1063552529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063552529 NPI number — FRANK DANIEL MONGIARDO M.D. P.S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK DANIEL MONGIARDO M.D. P.S.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
APPALACHIAN REGIONAL HEAD & NECK CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063552529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 2N
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41701-9466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-439-4466
Provider Business Mailing Address Fax Number:
606-439-1941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 2N
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-9466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-4466
Provider Business Practice Location Address Fax Number:
606-439-1941
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONGIARDO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
606-439-4466

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  25357 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 4979P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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