1689676686 NPI number — NEVEN JOHN GARDNER MD

Table of content: NEVEN JOHN GARDNER MD (NPI 1689676686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689676686 NPI number — NEVEN JOHN GARDNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
NEVEN
Provider Middle Name:
JOHN
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:
1689676686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKYLAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28776-2209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-341-8067
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 PASADENA DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-2973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-276-1452
Provider Business Practice Location Address Fax Number:
859-277-1237
Provider Enumeration Date:
08/10/2005

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: 207K00000X , with the licence number:  19637 , 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: 64196371 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710017290 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1275307 . This is a "MEDICARE INDIVIDUAL #" identifier . This identifiers is of the category "OTHER".




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