1417040742 NPI number — DR. KUNNATHU P. GEEVARGHESE MD

Table of content: NICHOLE EILEEN FELLER PA-C (NPI 1306329487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417040742 NPI number — DR. KUNNATHU P. GEEVARGHESE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEEVARGHESE
Provider First Name:
KUNNATHU
Provider Middle Name:
P.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1417040742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4402 CHURCHMAN AVE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40215-1190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-366-7317
Provider Business Mailing Address Fax Number:
502-366-7318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4402 CHURCHMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40215-1190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-366-7317
Provider Business Practice Location Address Fax Number:
502-366-7318
Provider Enumeration Date:
09/30/2006

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: 207L00000X , with the licence number:  16440 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 16440 , 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: 1131109 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050078005 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: C3647401 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000187640 . This is a "KY STATE DISTRICT CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000187640 . This is a "ONE NATION BENEFIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40090988000 . This is a "COMP MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64164403 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2437681000 . This is a "PASSPORT ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000187640 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004012479 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000187460 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000187640 . This is a "KY ACCESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64164403 . This is a "KENPAC" identifier . This identifiers is of the category "OTHER".




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