1558741736 NPI number — ZHOU PAIN MANAGEMENT CENTER

Table of content: (NPI 1558741736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558741736 NPI number — ZHOU PAIN MANAGEMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZHOU PAIN MANAGEMENT CENTER
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:
1558741736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 S HURSTBOURNE PKWY STE 120
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:
40222-5757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-425-3225
Provider Business Mailing Address Fax Number:
502-423-3225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 S HURSTBOURNE PKWY
Provider Second Line Business Practice Location Address:
UNIT 120
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-3225
Provider Business Practice Location Address Fax Number:
502-425-3225
Provider Enumeration Date:
06/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ZHOU
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-423-3225

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100360490 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201323500A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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