1558533158 NPI number — BEN E. KITCHENS

Table of content: (NPI 1558533158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558533158 NPI number — BEN E. KITCHENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEN E. KITCHENS
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:
IUKA FAMILY CLINIC
Provider Other Organization Name Type Code:
3
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:
1558533158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 KAKI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IUKA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38852-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-423-3662
Provider Business Mailing Address Fax Number:
662-423-2509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 KAKI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IUKA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38852-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-423-3662
Provider Business Practice Location Address Fax Number:
662-423-2509
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KITCHENS
Authorized Official First Name:
BEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
662-423-3662

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  6296 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0123644 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com