1750509964 NPI number — KATOPES & ASSOCIATES, PC

Table of content: (NPI 1750509964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750509964 NPI number — KATOPES & ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATOPES & ASSOCIATES, PC
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:
WOODPARK MEDICAL CENTER
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:
1750509964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 WOODPARK PL BLG C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-3764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-926-4150
Provider Business Mailing Address Fax Number:
770-874-0452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 WOODPARK PL BLDG C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-926-4150
Provider Business Practice Location Address Fax Number:
770-874-0452
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TODD
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
INSURANCE DEPT. MANAGER
Authorized Official Telephone Number:
770-926-4150

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 055001022A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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