1770783995 NPI number — DHOLAKIA AND ASSOCIATES, PSC

Table of content: (NPI 1770783995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770783995 NPI number — DHOLAKIA AND ASSOCIATES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHOLAKIA AND ASSOCIATES, PSC
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:
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:
1770783995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2315 CUMBERLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLESBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40965-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-248-0508
Provider Business Mailing Address Fax Number:
606-248-2030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 CUMBERLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-248-0507
Provider Business Practice Location Address Fax Number:
606-248-2030
Provider Enumeration Date:
07/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DHOLAKIA
Authorized Official First Name:
SATISH
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-248-0507

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  23759 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: 23755 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65929713 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".