1750559233 NPI number — DR. MOLLY V HOUSER MD, CDE

Table of content: DR. MOLLY V HOUSER MD, CDE (NPI 1750559233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750559233 NPI number — DR. MOLLY V HOUSER MD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSER
Provider First Name:
MOLLY
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, CDE
Provider Gender Code:
F

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:
1750559233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4071 TATES CREEK CENTRE DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-3062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 NICHOLASVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 703
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-260-4390
Provider Business Practice Location Address Fax Number:
859-260-4399
Provider Enumeration Date:
02/18/2008

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: 207VM0101X , with the licence number:  2008010217 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 44607 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VM0101X , with the licence number: 46040 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 01071699A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000727424 . This is a "ANTHEM - NMFM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 128445 . This is a "SIHO - NMFM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50034669 . This is a "PASSPORT - NMFM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100179800 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201035550 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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