1912900853 NPI number — WILLIAM E CHILDERS M.D.

Table of content: WILLIAM E CHILDERS M.D. (NPI 1912900853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912900853 NPI number — WILLIAM E CHILDERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDERS
Provider First Name:
WILLIAM
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1912900853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 CROSSFIELD DR
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
VERSAILLES
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40383-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-873-9843
Provider Business Mailing Address Fax Number:
859-873-0972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 CROSSFIELD DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
VERSAILLES
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40383-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-873-9843
Provider Business Practice Location Address Fax Number:
859-873-0972
Provider Enumeration Date:
05/24/2005

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:  21525 , 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: 000000047822 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 110031154 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0400353 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0037679 . This is a "MEDICARE - FAYETTE COUNTY HEALTH DEPARTMENT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1404232 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611012421004 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64100696 . This is a "MEDICAID - FAYETTE COUNTY HEALTH DEPARTMENT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64215254 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1284109 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611012421E . This is a "HUMANA HMO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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