1639353642 NPI number — HAROLD W OWENS, M.D.

Table of content: (NPI 1639353642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639353642 NPI number — HAROLD W OWENS, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLD W OWENS, M.D.
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:
6
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:
1639353642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40146-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-547-2011
Provider Business Mailing Address Fax Number:
270-547-2031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 CAROLINE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40146-0367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-547-2011
Provider Business Practice Location Address Fax Number:
270-547-2031
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
WILBUR
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
270-547-2011

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  13345 , 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: 64133457 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000062613 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011769099 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1265701 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1049319 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".




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