1285909788 NPI number — HOUSAM I HADDAD MEDICAL PRACTICE, PLLC

Table of content: ERIN EILEEN COX D.O. (NPI 1649298159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285909788 NPI number — HOUSAM I HADDAD MEDICAL PRACTICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSAM I HADDAD MEDICAL PRACTICE, PLLC
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:
1285909788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1519
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42539-1519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-327-7283
Provider Business Mailing Address Fax Number:
606-787-0251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
187 WOLFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42539-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-327-7283
Provider Business Practice Location Address Fax Number:
800-591-6398
Provider Enumeration Date:
03/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HADDAD
Authorized Official First Name:
HOUSAM
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
859-327-7283

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  31531 , 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: 64315310 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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