1629014675 NPI number — DR. KAREN AVANESOV D.O

Table of content: DR. KAREN AVANESOV D.O (NPI 1629014675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629014675 NPI number — DR. KAREN AVANESOV D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVANESOV
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
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:
1629014675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E GRAY ST
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-584-7525
Provider Business Mailing Address Fax Number:
502-584-6851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E GRAY ST
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-7525
Provider Business Practice Location Address Fax Number:
502-584-6851
Provider Enumeration Date:
06/20/2006

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: 204D00000X , with the licence number:  238138 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 03167 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0117X , with the licence number: 238138 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 238138 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3740627000 . This is a "PASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100084130 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50025970 . This is a "PASSPORT- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200952070 . This is a "SIHO- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000628579 . This is a "ANTHEM- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000051983P . This is a "HUMANA- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533170 . This is a "ADVANTRA FREEDOM- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200952070 . This is a "HEALTHY INDIANA PLAN- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200952070 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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