1144411638 NPI number — MS. KARLA KAY IMBUS PA-C

Table of content: MS. KARLA KAY IMBUS PA-C (NPI 1144411638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144411638 NPI number — MS. KARLA KAY IMBUS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IMBUS
Provider First Name:
KARLA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1144411638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MEDICAL VILLAGE DRIVE
Provider Second Line Business Mailing Address:
SUITE 258
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017
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:
7655 FIVE MILE ROAD
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-624-7525
Provider Business Practice Location Address Fax Number:
513-624-0578
Provider Enumeration Date:
08/08/2007

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: 363A00000X , with the licence number:  50.001491 , 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: 352199392 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000611444 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com