1194866822 NPI number — WIGGINS DRUGS LIMITED

Table of content: (NPI 1194866822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194866822 NPI number — WIGGINS DRUGS LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIGGINS DRUGS LIMITED
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:
KING HOME CARE HENDERSON
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:
1194866822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 W CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42347-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 N GREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42420-2747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-827-8773
Provider Business Practice Location Address Fax Number:
270-827-8014
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAYDEN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
270-298-0259

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1381 , 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: 90010927 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1829970 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1829970 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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