1013919091 NPI number — PULMONARY ASSOCIATES OF OWENSBORO PSC

Table of content: (NPI 1013919091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013919091 NPI number — PULMONARY ASSOCIATES OF OWENSBORO PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY ASSOCIATES OF OWENSBORO 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:
1013919091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1875
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-1875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-926-8810
Provider Business Mailing Address Fax Number:
270-926-7955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BRECKENRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-0839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-8810
Provider Business Practice Location Address Fax Number:
270-926-7955
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
O'BRYAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
270-926-8810

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , 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: 15D5 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78902335 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021103000 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200034800A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65925059 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK4221 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com