1326137217 NPI number — EAST LOUISVILLE DENTAL GROUP

Table of content: AMY MARIE HOOGSTRA MSN, FNP-BC (NPI 1902348220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326137217 NPI number — EAST LOUISVILLE DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST LOUISVILLE DENTAL GROUP
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:
F. RICHARD SCHMITT DMD PSC
Provider Other Organization Name Type Code:
4
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:
1326137217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 43300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40253-0300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-245-5418
Provider Business Mailing Address Fax Number:
502-245-5429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MOSER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-5418
Provider Business Practice Location Address Fax Number:
502-245-5429
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMITT
Authorized Official First Name:
F.
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-245-5418

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4843 , 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)





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