1134385230 NPI number — CORBIN RURAL HEALTH CENTER PLLC

Table of content: (NPI 1134385230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134385230 NPI number — CORBIN RURAL HEALTH CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORBIN RURAL HEALTH CENTER PLLC
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:
1134385230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
870 CORPORATE DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-5416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-9436
Provider Business Mailing Address Fax Number:
859-977-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 MASTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-1065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-280-7772
Provider Business Practice Location Address Fax Number:
606-620-5416
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-524-0966

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  1077883 , 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: 000000522081 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78006202 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00305163 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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