1215987227 NPI number — DR. MARILYN J CONNORS D.O.

Table of content: DR. MARILYN J CONNORS D.O. (NPI 1215987227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215987227 NPI number — DR. MARILYN J CONNORS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNORS
Provider First Name:
MARILYN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1215987227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1595
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41105-1595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-408-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 N CAROL MALONE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAYSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41143-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-474-7892
Provider Business Practice Location Address Fax Number:
606-474-0040
Provider Enumeration Date:
05/11/2006

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: 207Q00000X , with the licence number:  231855 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 1103 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 03296 , 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: 3085101 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810018418 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00873783 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100129340 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011036 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02550365 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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