1285942649 NPI number — ERENA & PETERSON, PLLC

Table of content: (NPI 1285942649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285942649 NPI number — ERENA & PETERSON, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERENA & PETERSON, 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:
1285942649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 PERIMETER DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-4125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-268-4423
Provider Business Mailing Address Fax Number:
859-268-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 PERIMETER DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-4125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-268-4423
Provider Business Practice Location Address Fax Number:
859-268-0010
Provider Enumeration Date:
09/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HINTON
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
859-268-4423

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100158900 . This is a "MEDICAID MEDICAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100150110 . This is a "MEDICAID DENTAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P100036989 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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