1629033402 NPI number — JOSHUA N QUAYE MD

Table of content: JOSHUA N QUAYE MD (NPI 1629033402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629033402 NPI number — JOSHUA N QUAYE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAYE
Provider First Name:
JOSHUA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629033402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7926 PRESTON HWY
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40219-3848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-968-3010
Provider Business Practice Location Address Fax Number:
502-968-0035
Provider Enumeration Date:
04/18/2006

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: 208D00000X , with the licence number:  37458 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 37458 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000231222 . This is a "ANTHEM / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000023035B . This is a "HUMANA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64052467 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00421531 . This is a "RRMCR FOR ICC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1166637 . This is a "PASSPORT / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2440065000 . This is a "PASSPORT ADVANTAGE / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1197541 . This is a "CHA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200832700 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010066030 . This is a "RRMCR FOR ICC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 017190 . This is a "SIHO / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110240090 . This is a "RR MCR FOR NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3170255001 . This is a "CIGNA / NCMA" identifier . This identifiers is of the category "OTHER".