1518079649 NPI number — DR. KENNETH J PAYNE M.D.

Table of content: DR. KENNETH J PAYNE M.D. (NPI 1518079649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518079649 NPI number — DR. KENNETH J PAYNE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
KENNETH
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1518079649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-272-5100
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S FLOYD ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-1515
Provider Business Practice Location Address Fax Number:
502-629-1545
Provider Enumeration Date:
08/31/2006

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: 207V00000X , with the licence number:  40305 , 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: 3738590 . This is a "CIGNA- LUIS M. VELASCO, MD & ASSOC." identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000641999 . This is a "ANTHEM- LUIS M. VELASCO, MD & ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50027081 . This is a "PASSPORT- LUIS M. VELASCO, MD & ASSOC." identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64121569 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110222 . This is a "SIHO- LUIS M. VELASCO, MD & ASSOC." identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2691832 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00861080 . This is a "RAILROAD MEDICARE- LUIS M. VELASCO, MD & ASSOC." identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000052152U . This is a "HUMANA- LUIS VELASCO, MD & ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200979140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3760421000 . This is a "PASSPORT ADVANTAGE- LUIS M. VELASCO, MD & ASSOC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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