1053311621 NPI number — DR. CHRISTOPHER C GLASER MD

Table of content: DR. CHRISTOPHER C GLASER MD (NPI 1053311621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053311621 NPI number — DR. CHRISTOPHER C GLASER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASER
Provider First Name:
CHRISTOPHER
Provider Middle Name:
C
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:
1053311621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 NEW HARTFORD RD
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:
42303-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-683-3720
Provider Business Mailing Address Fax Number:
270-686-7331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 NEW HARTFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-683-3720
Provider Business Practice Location Address Fax Number:
270-686-7331
Provider Enumeration Date:
07/26/2005

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: 2086S0129X , with the licence number:  01046162 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 01046162 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 29587 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 29587 , 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: 020034764 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611059472 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6110594722108 . This is a "CARESOURCE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000048411 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64295876 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611059472 . This is a "DART" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100329290 . This is a "MOLINA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100329290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".