1679503106 NPI number — BENJAMIN HOMER MCQUAIDE M.D.

Table of content: LUCAS TRIEMSTRA P.A.-C (NPI 1083952998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679503106 NPI number — BENJAMIN HOMER MCQUAIDE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCQUAIDE
Provider First Name:
BENJAMIN
Provider Middle Name:
HOMER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1679503106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40602-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-226-3858
Provider Business Mailing Address Fax Number:
502-223-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 EASTERN BYP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-623-8827
Provider Business Practice Location Address Fax Number:
859-623-8810
Provider Enumeration Date:
07/03/2006

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: 2085R0202X , with the licence number:  28886 , 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: 64288863 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000216573 . This is a "ANTHEM BLUE CROSS PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: G04506 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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