1336120039 NPI number — STEVEN PETER NOLL DO

Table of content: MR. LI CHEN (NPI 1801274485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336120039 NPI number — STEVEN PETER NOLL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLL
Provider First Name:
STEVEN
Provider Middle Name:
PETER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1336120039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MEDICAL VILLIAGE DR
Provider Second Line Business Mailing Address:
STE 258
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-7246
Provider Business Mailing Address Fax Number:
859-341-7867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
INDEPENDENT ANESTHESIOLOGISTS PSC
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7246
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
11/09/2005

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: 207L00000X , with the licence number:  02200 , 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: 000000033280 . This is a "ANTHEM BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0958870 . This is a "MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 10826428 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2532691 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64022007 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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