1598870727 NPI number — GREGORY B. NAZAR, M.D., 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 1598870727 NPI number — GREGORY B. NAZAR, M.D., PSC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY B. NAZAR, M.D., 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:
1598870727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 AUDUBON PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-636-2667
Provider Business Mailing Address Fax Number:
502-636-2668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 AUDUBON PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-2667
Provider Business Practice Location Address Fax Number:
502-636-2668
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATE
Authorized Official First Name:
FAWN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
502-636-2667

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  26253 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3003327 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 3006765 , 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: 7100204780 NPGRP , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100198630 MDGRP , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50023701 . This is a "PASSPORT GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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