1699861831 NPI number — DR. KATHRYN SUE REINHARDT BUCSHON MD

Table of content: DR. KATHRYN SUE REINHARDT BUCSHON MD (NPI 1699861831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699861831 NPI number — DR. KATHRYN SUE REINHARDT BUCSHON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCSHON
Provider First Name:
KATHRYN
Provider Middle Name:
SUE REINHARDT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REINHARDT
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699861831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47732-3366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-2240
Provider Business Mailing Address Fax Number:
812-450-2710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12613 CHESDIN LANDING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23838-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-301-4830
Provider Business Practice Location Address Fax Number:
804-863-4626
Provider Enumeration Date:
10/05/2006

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: 207L00000X , with the licence number:  01049634A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000216536 . This is a "BCBS PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000500998 . This is a "BCBS - DEACONESS GATEWAY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200271630 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00365276 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 64043730 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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