1659454924 NPI number — MORGAN-HAUGH PROFESSIONAL SERVICES CORPORATION

Table of content: (NPI 1659454924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659454924 NPI number — MORGAN-HAUGH PROFESSIONAL SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORGAN-HAUGH PROFESSIONAL SERVICES CORPORATION
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:
MORGAN-HAUGH MEDICAL GROUP
Provider Other Organization Name Type Code:
3
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:
1659454924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 MEDICAL CENTER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42066-1194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-247-8100
Provider Business Mailing Address Fax Number:
270-247-7780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 MEDICAL CENTER CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42066-1194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-247-8100
Provider Business Practice Location Address Fax Number:
270-247-7780
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAAKSMA
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
270-650-7138

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 41115 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 00328 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 917 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: 27345 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 2813P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3370270 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE3275 . This is a "RR GRP NO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0421 . This is a "MEDICAID SITE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6590034200 . This is a "MEDICAID GRP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: B08239004 . This is a "MEDICARE DME SUBMITTER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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