1801893888 NPI number — GREGORY R. ERENA, P.S.C.

Table of content: (NPI 1801893888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801893888 NPI number — GREGORY R. ERENA, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY R. ERENA, P.S.C.
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:
1801893888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 PERIMETER DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-4125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-268-4423
Provider Business Mailing Address Fax Number:
859-268-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 PERIMETER DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-4125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-268-4423
Provider Business Practice Location Address Fax Number:
859-268-0010
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ERENA
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-268-4423

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3978 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61900486 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65936221 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com