1427263888 NPI number — DR. JOAN LEE KOGELSCHATZ PHD

Table of content: (NPI 1326717190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427263888 NPI number — DR. JOAN LEE KOGELSCHATZ PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOGELSCHATZ
Provider First Name:
JOAN
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1427263888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 HONEYSUCKLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-1934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-0719
Provider Business Mailing Address Fax Number:
334-671-4547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 HONEYSUCKLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-0719
Provider Business Practice Location Address Fax Number:
334-671-4547
Provider Enumeration Date:
05/11/2007

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: 101YP2500X , with the licence number:  143 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PY3209 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 0647C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: L33 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1886 . This is a "AMERICAN BEHAVIORAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 3001795 . This is a "CERIDIAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 602389KOG . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 17982 . This is a "BEHAVIORAL HEALTH SYSTEMS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511/01620 . This is a "MHCA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: POO397561 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 103651 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4381654 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 81870 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 111860 . This is a "COMPSYCH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 120776000 . This is a "MAGELLAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51041883 . This is a "BC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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