1245204593 NPI number — SARA L MCNALLY CRNA

Table of content: SARA L MCNALLY CRNA (NPI 1245204593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245204593 NPI number — SARA L MCNALLY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNALLY
Provider First Name:
SARA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1245204593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9050 BARBOURVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40744-9327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-878-1860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N NAPPANEE ST
Provider Second Line Business Practice Location Address:
STE 11-B
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46514-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-522-9922
Provider Business Practice Location Address Fax Number:
574-522-9926
Provider Enumeration Date:
02/14/2006

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: 367500000X , with the licence number:  2667A , 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: 000000380611 . This is a "ANTHEM PROVIDER #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-1427889 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: C20863 . This is a "CUMBERLAND HEALTHCARE INC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-1427889 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-1427889 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-1427889 . This is a "UHC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 030670000 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00314943 . This is a "RRMCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 61-1427889 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50008567 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 74026675 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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