1073777694 NPI number — PHILLIP B KLAPPER MD PSC

Table of content: (NPI 1073777694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073777694 NPI number — PHILLIP B KLAPPER MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILLIP B KLAPPER MD PSC
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:
1073777694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 S 8TH ST
Provider Second Line Business Mailing Address:
STE 304 E
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42071-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-759-4811
Provider Business Mailing Address Fax Number:
270-767-3625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S 8TH ST
Provider Second Line Business Practice Location Address:
STE 304 E
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-759-4811
Provider Business Practice Location Address Fax Number:
270-767-3625
Provider Enumeration Date:
07/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLAPPER
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
270-759-4811

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  19477 , 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: 000000047166 . This is a "ANTHEM, BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64194772 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 409013579 . This is a "RAILROAD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".