1215009691 NPI number — BRUCE SNIDER MD PSC

Table of content: (NPI 1215009691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215009691 NPI number — BRUCE SNIDER MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE SNIDER MD PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1215009691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 GRAVES AVE STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERLANGER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41018-3309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-5014
Provider Business Mailing Address Fax Number:
859-341-5136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 GRAVES AVE STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERLANGER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41018-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-5014
Provider Business Practice Location Address Fax Number:
859-341-5136
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNIDER
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
859-341-5014

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  16835 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64168354 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com