1174528392 NPI number — KENDALL E HANSEN MD PLC

Table of content: (NPI 1174528392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174528392 NPI number — KENDALL E HANSEN MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENDALL E HANSEN MD PLC
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:
INTERVENTIONAL PAIN SPECIALISTS
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:
1174528392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 634
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41022-0634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-957-0700
Provider Business Mailing Address Fax Number:
859-957-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 THOMAS MORE PKWY.
Provider Second Line Business Practice Location Address:
STE. 260
Provider Business Practice Location Address City Name:
CRESTVIEW HILLS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-957-0700
Provider Business Practice Location Address Fax Number:
859-957-0703
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
KENDALL
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
M.D., PRESIDENT & CEO
Authorized Official Telephone Number:
859-957-0700

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65933624 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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