1528156866 NPI number — WEST KENTUCKY RHEUMATOLOGY,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 1528156866 NPI number — WEST KENTUCKY RHEUMATOLOGY,PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST KENTUCKY RHEUMATOLOGY,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:
1528156866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 AUGUSTA AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42003-5584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-534-0046
Provider Business Mailing Address Fax Number:
270-534-0048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 AUGUSTA AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-5584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-534-0046
Provider Business Practice Location Address Fax Number:
270-534-0048
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT/VICE PRESIDENT
Authorized Official Telephone Number:
270-534-0046

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  26804 , 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: 145768 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000049267 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 029602 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3145428 . This is a "BLUE CROSS/SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".