1902846157 NPI number — MR. IBRAHIM FAHSAH MD

Table of content: MR. IBRAHIM FAHSAH MD (NPI 1902846157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902846157 NPI number — MR. IBRAHIM FAHSAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAHSAH
Provider First Name:
IBRAHIM
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1902846157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 909
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:
40201-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-916-1055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 ABRAHAM FLEXNER WAY STE 903
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-916-1055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006

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: 174400000X , with the licence number:  32990 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 32990 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 32990 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 32990 , 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: 50019752 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000057094O . This is a "HUMANA- CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 353176400 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50031678 . This is a "PASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 108285 . This is a "ANTHEM- CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200122110 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5151604 . This is a "AETNA- CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00468647 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64329907 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00924103 . This is a "RAILROAD MEDICARE- CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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