1821153396 NPI number — MINIX EYE CLINIC, INC.

Table of content: (NPI 1821153396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821153396 NPI number — MINIX EYE CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINIX EYE CLINIC, INC.
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:
6
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:
1821153396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
327 MAYO PLAZA
Provider Second Line Business Mailing Address:
BOX 1687
Provider Business Mailing Address City Name:
PAINTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-789-2020
Provider Business Mailing Address Fax Number:
606-789-2019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 MAYO PLAZA
Provider Second Line Business Practice Location Address:
BOX 1687
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-2020
Provider Business Practice Location Address Fax Number:
606-789-2019
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINIX
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
606-789-2020

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  KY0407 , 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: 52904075 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180014427 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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