1073174678 NPI number — KEVIN TAYLOR SPENCE

Table of content: KEVIN TAYLOR SPENCE (NPI 1073174678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073174678 NPI number — KEVIN TAYLOR SPENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCE
Provider First Name:
KEVIN
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1073174678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UPMC PINNACLE 205 S FRONT ST
Provider Second Line Business Mailing Address:
GENERAL SURGERY RESIDENCY BRADY 916
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-231-8755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12600 CANTRELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72223-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-605-7676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2019

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: 390200000X , with the licence number:  MT219075 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: E-17872 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: MT219075 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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