1114955093 NPI number — NORTON - KINGS DAUGHTERS HEALTH INC

Table of content: (NPI 1114955093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114955093 NPI number — NORTON - KINGS DAUGHTERS HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTON - KINGS DAUGHTERS HEALTH 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:
1114955093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47732-3395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-801-0715
Provider Business Mailing Address Fax Number:
812-265-6603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1373 E STATE ROAD 62
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47250-7328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-801-0800
Provider Business Practice Location Address Fax Number:
812-265-6603
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAST
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, MANAGED CARE
Authorized Official Telephone Number:
502-303-2329

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65903890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78901048 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100148960 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65928533 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200140910 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000056018 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100388910 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1170897 . This is a "PASSPORT MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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