1922182013 NPI number — DR. RICHARD FELLOWS MD

Table of content: DR. RICHARD FELLOWS MD (NPI 1922182013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922182013 NPI number — DR. RICHARD FELLOWS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELLOWS
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1922182013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950202
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:
40295-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-969-6552
Provider Business Mailing Address Fax Number:
502-969-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 E CHESTNUT ST
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:
40202-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-7661
Provider Business Practice Location Address Fax Number:
502-629-5309
Provider Enumeration Date:
10/25/2006

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: 2085P0229X , with the licence number:  18377 , 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: 000000544367 . This is a "ANTHEM - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3505502 . This is a "PASSPORT ADVTG - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50018757 . This is a "PASSPORT - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0000230291 . This is a "HUMANA KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100357970 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64183775 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00533031 . This is a "MEDICARE - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 92158 . This is a "SIHO - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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