1528156866 NPI number — WEST KENTUCKY RHEUMATOLOGY,PSC

Table of content: (NPI 1528156866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528156866 NPI number — WEST KENTUCKY RHEUMATOLOGY,PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST KENTUCKY RHEUMATOLOGY,PSC
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:
1528156866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 AUGUSTA AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42003-5584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-534-0046
Provider Business Mailing Address Fax Number:
270-534-0048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 AUGUSTA AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-5584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-534-0046
Provider Business Practice Location Address Fax Number:
270-534-0048
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT/VICE PRESIDENT
Authorized Official Telephone Number:
270-534-0046

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  26804 , 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: 145768 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000049267 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 029602 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3145428 . This is a "BLUE CROSS/SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".