1881146793 NPI number — ONE WAY GYNECOLOGY LLC

Table of content: (NPI 1881146793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881146793 NPI number — ONE WAY GYNECOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE WAY GYNECOLOGY LLC
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:
1881146793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 DANIEL DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-209-2018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 DANIEL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-209-2018
Provider Business Practice Location Address Fax Number:
859-209-4414
Provider Enumeration Date:
10/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
NADINE
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
859-209-2018

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  39011 , 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: 64078744 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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