1225208150 NPI number — RODERICK J. TOMPKINS JR MD PSC

Table of content: (NPI 1225208150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225208150 NPI number — RODERICK J. TOMPKINS JR MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODERICK J. TOMPKINS JR MD PSC
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:
1225208150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1353
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:
41105-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-329-2888
Provider Business Mailing Address Fax Number:
606-329-2890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 23RD ST STE 440
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-2888
Provider Business Practice Location Address Fax Number:
606-329-2890
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TOMPKINS
Authorized Official First Name:
RODERICK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-329-2888

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64328750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2026757 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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