1184689184 NPI number — RICHARD M SPALDING M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184689184 NPI number — RICHARD M SPALDING M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SPALDING

Provider First Name:

RICHARD

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1184689184

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/22/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 766351

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHICAGO

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60677-6351

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

502-588-9490

Provider Business Mailing Address Fax Number:

502-272-5116

Provider First Line Business Practice Location Address:

2051 CLEVIDENCE BLVD

Provider Second Line Business Practice Location Address:

STE. 1

Provider Business Practice Location Address City Name:

CLARKSVILLE

Provider Business Practice Location Address State Name:

IN

Provider Business Practice Location Address Postal Code:

47129-2278

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

812-280-9145

Provider Business Practice Location Address Fax Number:

812-280-6627

Provider Enumeration Date:

04/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  01034874A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: 20244 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 100191730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 2445888000 . This is a "PAD - NCMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 50004526 . This is a "PASSPORT -NCMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 120321P . This is a "SIHO - NCMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 64202443 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: P00711467 . This is a "RAILROAD MEDICARE KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 1193933 . This is a "CHA / NCMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 00000050972 . This is a "ANTHEM - NCMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2559361-001 . This is a "CIGNA / NCMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 110138279 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".