1316917131 NPI number — MR. JOHN B RASHIDIAN MD

Table of content: MR. JOHN B RASHIDIAN MD (NPI 1316917131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316917131 NPI number — MR. JOHN B RASHIDIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASHIDIAN
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1316917131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 N ELM STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-826-0838
Provider Business Mailing Address Fax Number:
270-830-0371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 N ELM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-826-0838
Provider Business Practice Location Address Fax Number:
270-830-0371
Provider Enumeration Date:
01/24/2006

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: 207V00000X , with the licence number:  20634 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 01033238A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 64206345 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20634 . This is a "LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".