1215001631 NPI number — MR. JAMES ARTHUR ZIEGE PT ABDA CEAS

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215001631 NPI number — MR. JAMES ARTHUR ZIEGE PT ABDA CEAS

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ZIEGE

Provider First Name:

JAMES

Provider Middle Name:

ARTHUR

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

PT ABDA CEAS

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:

1215001631

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/24/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

15027 MADISON PIKE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MORNING VIEW

Provider Business Mailing Address State Name:

KY

Provider Business Mailing Address Postal Code:

41063-9664

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

859-466-6355

Provider Business Mailing Address Fax Number:

859-356-0783

Provider First Line Business Practice Location Address:

318 N MAIN ST STE 1

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OWENTON

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40359-1430

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

502-462-0094

Provider Business Practice Location Address Fax Number:

502-462-1148

Provider Enumeration Date:

11/17/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  KY001712 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000061164 . This is a "ANTHEM COMMUNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 611317367 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
• Identifier: 8700008900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 6400193 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 611317367 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000000033127 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 1107782 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: AETNA . This is a "2056189" identifier . This identifiers is of the category "OTHER".
• Identifier: CHA . This is a "611317367" identifier . This identifiers is of the category "OTHER".
• Identifier: PT165 . This is a "CHOICECARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 611317367 . This is a "JF MOLLOY" identifier . This identifiers is of the category "OTHER".
• Identifier: 611317367 . This is a "BOILER MAKERS" identifier . This identifiers is of the category "OTHER".