1134100738 NPI number — ALAN ARNOLD GODOFSKY MD

Table of content: DR. EUGENE SIBAL D.M.D (NPI 1427460047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134100738 NPI number — ALAN ARNOLD GODOFSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODOFSKY
Provider First Name:
ALAN
Provider Middle Name:
ARNOLD
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:
1134100738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MEDICAL VILLAGE DR
Provider Second Line Business Mailing Address:
STE 258 ANETHESIA INTENSIVE CARE CONSULTANTS INC
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-5401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-7246
Provider Business Mailing Address Fax Number:
859-341-7867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 STATE RD
Provider Second Line Business Practice Location Address:
ANESTHESIA INTENSIVE CARE CONSULTANTS INC
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45255-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7246
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
11/10/2005

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: 207L00000X , with the licence number:  35 05 3644G , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00000077648 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000012632 . This is a "ANTHEM BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10757864 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31 1105593 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0713240 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200377690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64027980 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 728016 . This is a "BUCKEYE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311585770 1659350494 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




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