1346229515 NPI number — KEVIN H STROUP MD

Table of content: KEVIN H STROUP MD (NPI 1346229515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346229515 NPI number — KEVIN H STROUP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROUP
Provider First Name:
KEVIN
Provider Middle Name:
H
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:
1346229515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38351-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-968-3646
Provider Business Mailing Address Fax Number:
731-968-1870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38351-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-968-3646
Provider Business Practice Location Address Fax Number:
731-968-1870
Provider Enumeration Date:
01/16/2006

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: 207Q00000X , with the licence number:  23810 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TN0102 . This is a "AMERICHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 184234 . This is a "UNISON" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 484925 . This is a "MULTIPLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 184234 . This is a "BETTER HEALTH PLAN OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3835292 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 610916101 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4117685 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8167952 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 36935 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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