1285613612 NPI number — OWENSBORO HEALTH INC

Table of content: (NPI 1285613612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285613612 NPI number — OWENSBORO HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OWENSBORO HEALTH INC
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:
6
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:
1285613612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20007
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:
42304-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-417-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 PLEASANT VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-9811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-417-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANALLO
Authorized Official First Name:
RUSS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official Telephone Number:
270-685-7180

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  100092 , 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: 080138000 . This is a "BLACK LUNG PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000054926 . This is a "ANTHEM BCBS KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 163998900 . This is a "DEPT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100275690A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200134380 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1022441 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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