1063484483 NPI number — HOSPITAL OF LOUISA, INC.

Table of content: (NPI 1063484483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063484483 NPI number — HOSPITAL OF LOUISA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL OF LOUISA, 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:
1063484483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63160-0990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2485 HIGHWAY 644
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-9242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-9451
Provider Business Practice Location Address Fax Number:
606-638-9494
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
SVP FINANCE OP/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-221-3840

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  100282 , 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: 129 . This is a "ANTHEM BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01022292 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030527200 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000319438 . This is a "MOUNTAIN STATE BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1457524 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1069693 . This is a "PASSPORT HLTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000065267 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001027000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0968681 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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