1174825962 NPI number — GORDON P GUTHRIE, JR., M.D. PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174825962 NPI number — GORDON P GUTHRIE, JR., M.D. PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDON P GUTHRIE, JR., M.D. 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:
1174825962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1985
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:
40588-1985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-8179
Provider Business Mailing Address Fax Number:
859-277-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 NICHOLASVILLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-275-1943
Provider Business Practice Location Address Fax Number:
859-277-8999
Provider Enumeration Date:
11/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GUTHRIE
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
859-275-1943

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  18859 , 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: 64188592 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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