1194849018 NPI number — DINAH GALE BAUSCH IECE.,MASE

Table of content: DINAH GALE BAUSCH IECE.,MASE (NPI 1194849018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194849018 NPI number — DINAH GALE BAUSCH IECE.,MASE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUSCH
Provider First Name:
DINAH
Provider Middle Name:
GALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IECE.,MASE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAGRACY
Provider Other First Name:
DINAH
Provider Other Middle Name:
GALE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
IECE, MASE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194849018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 N WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40069-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-481-2672
Provider Business Mailing Address Fax Number:
859-554-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40069-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-481-2672
Provider Business Practice Location Address Fax Number:
859-554-2725
Provider Enumeration Date:
03/17/2007

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: 222Q00000X , 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)