1063737864 NPI number — C & T HEALTHCARE PLLC

Table of content: DR. ROBERT L. JACOBSON M.D. (NPI 1174590152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063737864 NPI number — C & T HEALTHCARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C & T HEALTHCARE PLLC
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:
Provider Other Organization Name Type Code:
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:
1063737864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87
Provider Second Line Business Mailing Address:
8070 US HWY 60 WEST
Provider Business Mailing Address City Name:
LEWISPORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42351-7087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-295-3400
Provider Business Mailing Address Fax Number:
270-295-3401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8070 US HWY 60 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42351-7087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-295-3400
Provider Business Practice Location Address Fax Number:
270-295-3401
Provider Enumeration Date:
04/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
270-295-3400

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100129500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".