1649349911 NPI number — TRI COUNTY OB GYN ASSOCIATES PLC LLC

Table of content: (NPI 1649349911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649349911 NPI number — TRI COUNTY OB GYN ASSOCIATES PLC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI COUNTY OB GYN ASSOCIATES PLC LLC
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:
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:
1649349911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 NEW MOODY LN STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-9179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-222-5558
Provider Business Mailing Address Fax Number:
502-222-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 NEW MOODY LANE
Provider Second Line Business Practice Location Address:
TRI COUNTY OB GYN ASSOCIATES INC SUITE 103
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-5558
Provider Business Practice Location Address Fax Number:
502-222-3040
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPAULDING
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
STEWART
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
502-222-5558

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LW0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65935884 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2438489000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1149112 . This is a "AMERIHEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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