1275547606 NPI number — KENTUCKY FERTILITY AND GYNECOLOGY, PLLC.

Table of content: (NPI 1275547606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275547606 NPI number — KENTUCKY FERTILITY AND GYNECOLOGY, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY FERTILITY AND GYNECOLOGY, PLLC.
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:
KENTUCKY PRIMARY HEALTH CARE
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:
1275547606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 N EAGLE CREEK DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509-9087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-5736
Provider Business Mailing Address Fax Number:
859-276-2236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 N EAGLE CREEK DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-9087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-5736
Provider Business Practice Location Address Fax Number:
859-276-2236
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VELOUDIS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
MEMBER/PHYSICIAN
Authorized Official Telephone Number:
859-277-5736

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  02485 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA779 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65932980 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100107450 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275547606 . This is a "NPI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com