1487633426 NPI number — DAMON NEWSOME JR. P.A.

Table of content: RYAN MCINROY RPH (NPI 1982207254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487633426 NPI number — DAMON NEWSOME JR. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWSOME
Provider First Name:
DAMON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
P.A.
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:
1487633426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1709 KY ROUTE 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-9097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-886-8546
Provider Business Mailing Address Fax Number:
606-886-8548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 PARKWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALYERSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41465-9251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-3412
Provider Business Practice Location Address Fax Number:
606-298-5123
Provider Enumeration Date:
01/10/2006

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: 363AM0700X , with the licence number:  24870 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 024870 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07268739 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00176973 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000524189 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 95004933 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000559736001 . This is a "BCBS HIGHMARK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q00328306 . This is a "RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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