1790784320 NPI number — ARDEL C CAGATA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790784320 NPI number — ARDEL C CAGATA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAGATA
Provider First Name:
ARDEL
Provider Middle Name:
C
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:
CAGATA
Provider Other First Name:
ARDYLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790784320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
SERVICES BLDG, STE 303
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-6552
Provider Business Practice Location Address Fax Number:
502-629-3132
Provider Enumeration Date:
07/15/2005

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: 207R00000X , with the licence number:  30478 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 30478 , 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: 64304785 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200270800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3682676 . This is a "CIGNA - NICS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3730062000 . This is a "PASSPORT ADVANTAGE - NICS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000625001 . This is a "ANTHEM - NICS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 055105 . This is a "SIHO - NICS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611276316U . This is a "HUMANA - NICS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50025123 . This is a "PASSPORT - NICS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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