1346247129 NPI number — GEORGE H RUDWELL M.D.

Table of content: GEORGE H RUDWELL M.D. (NPI 1346247129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346247129 NPI number — GEORGE H RUDWELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDWELL
Provider First Name:
GEORGE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1346247129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 DUTCHMANS PKWY
Provider Second Line Business Mailing Address:
380
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40205-3372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-894-8441
Provider Business Mailing Address Fax Number:
812-283-0792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-283-0728
Provider Business Practice Location Address Fax Number:
812-283-0792
Provider Enumeration Date:
07/07/2005

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: 207Y00000X , with the licence number:  01020508 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , with the licence number: 15818 , 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: 040012437 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000045442 . This is a "ANTHEM FACET NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100047300A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64158181 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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