1316902109 NPI number — LORI M SCALES MD

Table of content: MR. STEVEN J KINNALLY PA-C (NPI 1184729543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316902109 NPI number — LORI M SCALES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCALES
Provider First Name:
LORI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMIDT
Provider Other First Name:
LORI
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316902109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HIGH POINT CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047-6560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-6129
Provider Business Practice Location Address Fax Number:
502-955-8161
Provider Enumeration Date:
04/18/2006

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: 208000000X , with the licence number:  35852 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 35852 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1208710 . This is a "CHA / NMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50001529 . This is a "PASSPORT / NMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00176818 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000350676 . This is a "ANTHEM / NMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023067 . This is a "SIHO / NMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000052154G . This is a "HUMANA / NMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2443114000 . This is a "PASSPORT ADVANTAGE / NMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64067580 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5843355 . This is a "CIGNA / NMA" identifier . This identifiers is of the category "OTHER".




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