1235165606 NPI number — PHYSICIANS AFFILIATED CARE P.S.C.

Table of content: (NPI 1235165606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235165606 NPI number — PHYSICIANS AFFILIATED CARE P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS AFFILIATED CARE P.S.C.
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:
GASTROINTESTINAL ENDOSCOPY CENTER OF OWENSBORO
Provider Other Organization Name Type Code:
3
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:
1235165606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1919
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-926-2273
Provider Business Mailing Address Fax Number:
270-926-5200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 E PARRISH AVE
Provider Second Line Business Practice Location Address:
BUILDING A
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-2273
Provider Business Practice Location Address Fax Number:
270-926-5200
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOARMAN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
270-926-2273

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000333384 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200491020A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36001345 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com