1558334466 NPI number — PHYSICIAN SERVICES PSC

Table of content: (NPI 1558334466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558334466 NPI number — PHYSICIAN SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN SERVICES 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:
1558334466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1713 NICHOLASVILLE 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:
40503-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-252-6500
Provider Business Mailing Address Fax Number:
859-224-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1721 NICHOLASVILLE 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:
40503-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-252-6500
Provider Business Practice Location Address Fax Number:
859-252-3073
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINDSOR
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-252-6500

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100241280 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100246380 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD2933 . This is a "RAILROAD MCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3810003494 . This is a "WV MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100241170 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100244620 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65926552 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100243230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2472800 . This is a "OHIO MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100241790 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90102344 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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