1831157411 NPI number — DR. STEVEN H PURSELL M.D.

Table of content: DR. STEVEN H PURSELL M.D. (NPI 1831157411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831157411 NPI number — DR. STEVEN H PURSELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURSELL
Provider First Name:
STEVEN
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1831157411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 E BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-629-2500
Provider Business Mailing Address Fax Number:
502-629-3166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3991 DUTCHMANS LN
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-899-3366
Provider Business Practice Location Address Fax Number:
502-899-3455
Provider Enumeration Date:
05/03/2006

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: 207VX0201X , with the licence number:  21436 , 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: 200009920 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4012785 . This is a "AETNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1112293 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000074659 . This is a "ANTHEM PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000020583G . This is a "HUMANA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2544745 . This is a "CIGNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 160048071 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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