1124293501 NPI number — THERESA B JAVIER INC

Table of content: (NPI 1124293501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124293501 NPI number — THERESA B JAVIER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERESA B JAVIER INC
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:
1124293501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3231 FURMAN BLVD
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:
40220-1949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-473-0529
Provider Business Mailing Address Fax Number:
502-458-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3231 FURMAN BLVD
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:
40220-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-473-0529
Provider Business Practice Location Address Fax Number:
502-458-5751
Provider Enumeration Date:
04/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAVIER
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
502-473-0529

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  KY1643 , 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)