1245238492 NPI number — ADVANCED PAIN MEDICINE, PSC

Table of content: (NPI 1245238492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245238492 NPI number — ADVANCED PAIN MEDICINE, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PAIN MEDICINE, 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:
1245238492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23955
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40523-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-271-3114
Provider Business Mailing Address Fax Number:
859-271-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PROSPEROUS PL
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-271-3114
Provider Business Practice Location Address Fax Number:
859-271-0220
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DUBAL
Authorized Official First Name:
SAROJ
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-271-3114

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C15401 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1168975 . This is a "CHA HEALTH PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65906067 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050076771 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000108103 . This is a "ANTHEM B/C & B/S PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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