1487783676 NPI number — MOBILITY PLUS HOMECARE, INC.

Table of content: MARIAH WOOD THAXTON P.A. (NPI 1174841647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487783676 NPI number — MOBILITY PLUS HOMECARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILITY PLUS HOMECARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1487783676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SYCAMORE ST
Provider Second Line Business Mailing Address:
SUITE 136
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42701-2469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-360-0486
Provider Business Mailing Address Fax Number:
270-360-1841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SYCAMORE ST
Provider Second Line Business Practice Location Address:
SUITE 136
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-2469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-360-0486
Provider Business Practice Location Address Fax Number:
270-360-1841
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AVERITT
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
270-360-0486

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  221831 , 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: 000000201522 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1129616 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 247572000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 90001686 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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