1578714440 NPI number — ANDREW M COUGHLIN M.D.

Table of content: ANDREW M COUGHLIN M.D. (NPI 1578714440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578714440 NPI number — ANDREW M COUGHLIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUGHLIN
Provider First Name:
ANDREW
Provider Middle Name:
M
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:
1578714440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23450-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-477-5240
Provider Business Mailing Address Fax Number:
757-463-6572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8303 DODGE ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-354-5048
Provider Business Practice Location Address Fax Number:
402-354-2585
Provider Enumeration Date:
10/08/2008

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: 207Y00000X , with the licence number:  27214 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: BP10032053 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0007X , with the licence number: 27214 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1578714440 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026485711 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100250444-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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