1326066911 NPI number — CARL L WATKINS MD

Table of content: CARL L WATKINS MD (NPI 1326066911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326066911 NPI number — CARL L WATKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
CARL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1326066911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 595
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42241-0595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-885-3414
Provider Business Mailing Address Fax Number:
270-885-7631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 E PARRISH AVE
Provider Second Line Business Practice Location Address:
BLDG D
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-8171
Provider Business Practice Location Address Fax Number:
270-852-7954
Provider Enumeration Date:
07/18/2006

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: 2085R0202X , with the licence number:  39546 , 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: 6412337500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000569164 . This is a "BCBS (COOPERATIVE HEALTH SERVICES INC.)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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