1144210337 NPI number — DR. WILLIAM MUDGE SLIGAR MD

Table of content: DR. WILLIAM MUDGE SLIGAR MD (NPI 1144210337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144210337 NPI number — DR. WILLIAM MUDGE SLIGAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLIGAR
Provider First Name:
WILLIAM
Provider Middle Name:
MUDGE
Provider Name Prefix Text:
DR.
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:
1144210337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4130 DUTCHMANS LN
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-897-1794
Provider Business Mailing Address Fax Number:
502-238-1286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3605 NORTHGATE CT STE 207
Provider Second Line Business Practice Location Address:
BLDG: NORTHGATE MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-6422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-1794
Provider Business Practice Location Address Fax Number:
502-238-1286
Provider Enumeration Date:
10/27/2005

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: 207X00000X , with the licence number:  29128 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 20278 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100074990 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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