1902851447 NPI number — MRS. CAROLYN E BROWN PT

Table of content: MRS. CAROLYN E BROWN PT (NPI 1902851447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902851447 NPI number — MRS. CAROLYN E BROWN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CAROLYN
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1902851447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 HIGHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-9154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-825-2158
Provider Business Mailing Address Fax Number:
270-825-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42078-8043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-988-7213
Provider Business Practice Location Address Fax Number:
270-988-2199
Provider Enumeration Date:
05/23/2006

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: 225100000X , with the licence number:  PT000361 , 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: 000000178635 . This is a "PROVIDER ID BLUE CROSS BL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8700020400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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