1235192451 NPI number — JOHN R DIMAR II MD

Table of content: JOHN R DIMAR II MD (NPI 1235192451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235192451 NPI number — JOHN R DIMAR II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMAR
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
II
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:
1235192451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E GRAY ST
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-7525
Provider Business Practice Location Address Fax Number:
502-589-0849
Provider Enumeration Date:
04/10/2006

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: 207XS0117X , with the licence number:  24311 , 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: 1049631 . This is a "PASSPORT (UNIVERSITY ORTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2432608000 . This is a "PASSPORT ADVANTAGE (UNIVE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3728038000 . This is a "PASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64243116 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00757242 . This is a "RAILROAD MEDICARE- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1054521 . This is a "PASSPORT (SPINE INSTITUTE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2433675000 . This is a "PASSPORT ADVANTAGE (SPINE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000049465 . This is a "ANTHEM (SPINE INSTITUTE)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100373930 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163722400 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000049348 . This is a "ANTHEM (UNIVERSITY ORTHOP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50024962 . This is a "PASSPORT- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: N291921 . This is a "HARMONY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000051983L . This is a "HUMANA- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200007231 . This is a "RAILROAD MEDICARE (SPINE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200031865 . This is a "RAILROAD MEDICARE (UNIVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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