1184932808 NPI number — CAPITAL FAMILY PHYSICIANS

Table of content: (NPI 1184932808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184932808 NPI number — CAPITAL FAMILY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL FAMILY PHYSICIANS
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:
CAPITAL CARDIOLOGY OR HEALTHWORKS
Provider Other Organization Name Type Code:
3
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:
1184932808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40604-4168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-223-5811
Provider Business Mailing Address Fax Number:
502-227-7379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 LEAWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-223-5811
Provider Business Practice Location Address Fax Number:
502-227-7379
Provider Enumeration Date:
09/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AMICK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
502-227-7188

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100103290 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100107740 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100108050 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95002085 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100102810 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100107790 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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