1972598050 NPI number — KMI ACQUISITION LLC

Table of content: (NPI 1972598050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972598050 NPI number — KMI ACQUISITION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KMI ACQUISITION 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:
THE BROOK HOSPITAL KMI
Provider Other Organization Name Type Code:
3
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:
1972598050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8521 LAGRANGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40242-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-426-6380
Provider Business Mailing Address Fax Number:
502-814-3711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8521 LAGRANGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40242-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-6380
Provider Business Practice Location Address Fax Number:
502-814-3711
Provider Enumeration Date:
09/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP CFO
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25460 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 100241 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: 100241 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 810229 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000054468 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100038830A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2685173000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008618000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 02021210 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2361377 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45027190 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000321602 . This is a "ANTHEM PROFESSIONAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50005909 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".