1144663220 NPI number — CLARK REGIONAL PHYSICIAN PRACTICES LLC

Table of content: (NPI 1144663220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144663220 NPI number — CLARK REGIONAL PHYSICIAN PRACTICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARK REGIONAL PHYSICIAN PRACTICES LLC
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:
CLARK DIGESTIVE CARE 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:
1144663220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40392-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-663-4946
Provider Business Mailing Address Fax Number:
606-663-8001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 200B
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40391-7676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-737-6488
Provider Business Practice Location Address Fax Number:
859-737-6649
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JUDY
Authorized Official First Name:
JESS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-372-8500

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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