1639112048 NPI number — PHILIP S KUO MD

Table of content: PHILIP S KUO MD (NPI 1639112048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639112048 NPI number — PHILIP S KUO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUO
Provider First Name:
PHILIP
Provider Middle Name:
S
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:
1639112048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 25TH AVE N STE 300B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-340-2275
Provider Business Mailing Address Fax Number:
615-340-2280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 25TH AVE N STE 300B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-340-2275
Provider Business Practice Location Address Fax Number:
615-340-2280
Provider Enumeration Date:
06/14/2006

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: 208M00000X , with the licence number:  38823 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 38823 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00355846 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6411791400 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4141507 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7951657 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3339636 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3339639 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6011194 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00377981 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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