1346304961 NPI number — DR. HERBERT E KOSMAHL D.P.M.

Table of content: DR. HERBERT E KOSMAHL D.P.M. (NPI 1346304961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346304961 NPI number — DR. HERBERT E KOSMAHL D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSMAHL
Provider First Name:
HERBERT
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1346304961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
795 RED BUD RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALHOUN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30701-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-629-1852
Provider Business Mailing Address Fax Number:
706-629-8004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
795 RED BUD RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALHOUN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30701-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-629-1852
Provider Business Practice Location Address Fax Number:
706-629-8004
Provider Enumeration Date:
12/20/2006

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: 213E00000X , with the licence number:  000501 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 154908 . This is a "BLUE CROSS BLUE SHIELD OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 480000726 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1390435 . This is a "CCN/FIRST HEALTH NETWORK" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000253877B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 267333 . This is a "GREAT WEST LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2512650 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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