1043674989 NPI number — UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043674989 NPI number — UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
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:
1043674989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
873 DENZIL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104-4026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-202-3318
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BAYLOR PLZ
Provider Second Line Business Practice Location Address:
BAYLOR COLLEGE OF MEDICINE, PATHOLOGY, MC 315
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-202-3318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
RUBY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
MEDICAL STUDENT
Authorized Official Telephone Number:
270-202-3318

Provider Taxonomy Codes

  • Taxonomy code: 284300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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