1497139042 NPI number — CENTRO HISPANO URGENCIAS MEDICAS

Table of content: (NPI 1497139042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497139042 NPI number — CENTRO HISPANO URGENCIAS MEDICAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO HISPANO URGENCIAS MEDICAS
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:
N/A
Provider Other Organization Name Type Code:
3
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:
1497139042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 E NEW CIRCLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40505-2619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-523-3797
Provider Business Mailing Address Fax Number:
859-523-3948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 E NEW CIRCLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40505-2619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-523-3797
Provider Business Practice Location Address Fax Number:
859-523-3948
Provider Enumeration Date:
07/14/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
RAFAEL
Authorized Official Title or Position:
CEO, MEDICAL DIRECTOR
Authorized Official Telephone Number:
859-523-3797

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  42437 , 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: 0962205 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100072140 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".