1043668841 NPI number — S.E.W. ENTERPRISES, INC.

Table of content: (NPI 1043668841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043668841 NPI number — S.E.W. ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.E.W. ENTERPRISES, 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:
1043668841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 W BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42066-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-247-3345
Provider Business Mailing Address Fax Number:
270-247-1344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 W BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42066-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-247-3345
Provider Business Practice Location Address Fax Number:
270-247-1344
Provider Enumeration Date:
06/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HAYDEN
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
270-247-3345

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0444294 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100030048 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200592576 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200974780 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600006911 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0104385 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200331440A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54029434 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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