1194727743 NPI number — DR. JAMES D HURT OD

Table of content: DR. JAMES D HURT OD (NPI 1194727743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194727743 NPI number — DR. JAMES D HURT OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURT
Provider First Name:
JAMES
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1194727743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 DUTCHMANS PKWY
Provider Second Line Business Mailing Address:
STE 125
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40205-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-896-8700
Provider Business Mailing Address Fax Number:
502-896-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1169 EASTERN PKWY STE 1211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-8700
Provider Business Practice Location Address Fax Number:
502-960-8138
Provider Enumeration Date:
08/12/2005

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: 152WC0802X , with the licence number:  18002127B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 1055DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1055DT , 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: 2200092 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: K001342 . This is a "TRICARE KENTUCKY OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911283 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000042390 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200189590A . This is a "MEDICAID MADISON OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410024957 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000062215 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: K001342 . This is a "TRICARE INDIANA OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1061182 . This is a "MEDICAID PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200189590B . This is a "MEDICAID LOUISVILLEOFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410010011 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4672263 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77010551 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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