1053304139 NPI number — NEIL R FARRIS MD

Table of content: NEIL R FARRIS MD (NPI 1053304139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053304139 NPI number — NEIL R FARRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRIS
Provider First Name:
NEIL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1053304139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 HARRODSBURG RD
Provider Second Line Business Mailing Address:
SUITE C215
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40504-3751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-9413
Provider Business Mailing Address Fax Number:
859-276-6381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 HARRODSBURG RD
Provider Second Line Business Practice Location Address:
SUITE C215
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-278-9413
Provider Business Practice Location Address Fax Number:
859-276-6381
Provider Enumeration Date:
08/24/2005

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:  21397 , 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: 000000047820 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611012421 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611012421B . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0400543 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 110056673 . This is a "RAILROAD MEDICARE" 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: 0400356 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-1012421 . This is a "TPN CONTRACTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611012421 . This is a "ESSENCE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: C68016 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0037677 . This is a "MEDICARE - FAYETTE COUNTY HEALTH DEPARTMENT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1284109 . This is a "UWMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64-213978 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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