1497752612 NPI number — ROBERT G MCHENDRIX III D.P.M.

Table of content: ROBERT G MCHENDRIX III D.P.M. (NPI 1497752612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497752612 NPI number — ROBERT G MCHENDRIX III D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCHENDRIX
Provider First Name:
ROBERT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
D.P.M.
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:
1497752612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3126 DIXIE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERLANGER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41018-1866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-331-4777
Provider Business Mailing Address Fax Number:
859-341-3133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3126 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ERLANGER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41018-1866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-4777
Provider Business Practice Location Address Fax Number:
859-341-3133
Provider Enumeration Date:
07/01/2005

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: 213E00000X , with the licence number:  00125 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: 00125 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ER0200X , with the licence number: K0125 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: K0125 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: K0125 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 80001258 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0245354 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0247710001 . This is a "MEDICARE DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 958792 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000033272 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 27-80420 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 406480106 . This is a "RAILROAD MEDICARE UHC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K0125 . This is a "HUMANA/CHOICE CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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