1114965134 NPI number — GENESIS MEDICAL INC.

Table of content: (NPI 1114965134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114965134 NPI number — GENESIS MEDICAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS MEDICAL 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:
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:
1114965134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1866 CAMPUS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40299-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-813-8630
Provider Business Mailing Address Fax Number:
502-371-5487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1866 CAMPUS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40299-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-813-8630
Provider Business Practice Location Address Fax Number:
502-371-5487
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC. DIRECTOR
Authorized Official Telephone Number:
502-813-8630

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4582393 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013063 . This is a "ACM MEDICAID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50001000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005097517 . This is a "AETNA PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200080970A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4535450 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2553848 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000097444 . This is a "ANTHEM BCBS #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000490400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009933653 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com