1144228164 NPI number — REBEKAH J WOODS D.O.

Table of content: REBEKAH J WOODS D.O. (NPI 1144228164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144228164 NPI number — REBEKAH J WOODS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
REBEKAH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1144228164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 NORTON HEALTHCARE BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-2845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-394-6460
Provider Business Practice Location Address Fax Number:
502-394-6465
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  02621 , 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: 157097 . This is a "SIHO-NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50065666 . This is a "PASSPORT-NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64075195 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50012296 . This is a "PASSPORT 2ND TO MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000617818 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000858393 . This is a "ANTHEM-NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2772075000 . This is a "PASSPORT ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 688594 . This is a "HEALTHLINK" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00719575 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000389675 . This is a "ANTHEM SR ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50012296 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".




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