1104043090 NPI number — KEVIN HOWARD DO

Table of content: KEVIN HOWARD DO (NPI 1104043090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104043090 NPI number — KEVIN HOWARD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
KEVIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1104043090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41105-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-928-1881
Provider Business Mailing Address Fax Number:
606-928-1776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2420 ARGILLITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLATWOODS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41139-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-836-3900
Provider Business Practice Location Address Fax Number:
606-836-0205
Provider Enumeration Date:
04/20/2007

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: 207Q00000X , with the licence number:  KY03037 , 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: 000000606886 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000522005 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2763326 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000650578 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100013740 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000653083 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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