1194033522 NPI number — DR. JOHN MARTIN KOGOY MD

Table of content: DR. JOHN MARTIN KOGOY MD (NPI 1194033522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194033522 NPI number — DR. JOHN MARTIN KOGOY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOGOY
Provider First Name:
JOHN
Provider Middle Name:
MARTIN
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:
1194033522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27877
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-0877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-8279
Provider Business Mailing Address Fax Number:
919-966-8796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 6TH AVE W STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-693-7230
Provider Business Practice Location Address Fax Number:
828-698-0583
Provider Enumeration Date:
09/20/2010

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: 208600000X , with the licence number:  2014-01328 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01468470 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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