1689954232 NPI number — MOREHEAD STATE UNIVERSITY

Table of content: (NPI 1689954232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689954232 NPI number — MOREHEAD STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOREHEAD STATE UNIVERSITY
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:
MOREHEAD STATE UNIVERSITY COUNSEL & HEALTH SERVICES
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:
1689954232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 ALLIE YOUNG HALL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40351-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-783-2885
Provider Business Mailing Address Fax Number:
606-783-9106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 ALLIE YOUNG HALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-783-2885
Provider Business Practice Location Address Fax Number:
606-783-9106
Provider Enumeration Date:
08/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH STEPHENS
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
606-783-2123

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 0668 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 03203 , 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: 3004857 , 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: 3796P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 3002104 , 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: 000000609845 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000623843 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00754288 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2973242 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30610026 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: K021100 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000231892 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2826311 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100092610 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000298213 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100034230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78010220 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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