1124018940 NPI number — CECIL STOKES MD

Table of content: CECIL STOKES MD (NPI 1124018940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124018940 NPI number — CECIL STOKES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOKES
Provider First Name:
CECIL
Provider Middle Name:
Provider Name Prefix Text:
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:
1124018940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 DIXIE HWY
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40258-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-587-4203
Provider Business Mailing Address Fax Number:
502-587-4155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-2877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-4203
Provider Business Practice Location Address Fax Number:
502-587-4155
Provider Enumeration Date:
10/24/2005

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: 207L00000X , with the licence number:  26897 , 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: 100002250 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64268972 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH6488 . This is a "RR MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 050065790 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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