1154393973 NPI number — PHYSICIAN SERVICES PSC

Table of content: (NPI 1154393973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154393973 NPI number — PHYSICIAN SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN SERVICES 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:
1154393973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40522-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-224-0090
Provider Business Mailing Address Fax Number:
859-224-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 HOUSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-282-8678
Provider Business Practice Location Address Fax Number:
859-282-8679
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-252-6500

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2472800 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026130003 . This is a "NSC - DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65926552 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810003494 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD2933 . This is a "RRMCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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