1548225576 NPI number — DAVID E TATE M.D.

Table of content: DAVID E TATE M.D. (NPI 1548225576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548225576 NPI number — DAVID E TATE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
DAVID
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1548225576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-969-6552
Provider Business Mailing Address Fax Number:
502-212-1358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E BROADWAY
Provider Second Line Business Practice Location Address:
STE 195
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-4263
Provider Business Practice Location Address Fax Number:
502-629-4282
Provider Enumeration Date:
04/20/2006

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: 207X00000X , with the licence number:  32802 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 32802 , 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: 200822720 . This is a "HEALTHY INDIANA PLAN- LOUISVILLE ARM AND HAND" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64119571 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000507566 . This is a "ANTHEM - LAH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 069472 . This is a "SIHO - LAH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2808156000 . This is a "PASSPORT ADVANTAGE - LAH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50013626 . This is a "PASSPORT - LAH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00365516 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023025U . This is a "HUAMANA - L:AH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200822720 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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