1346371879 NPI number — SHUGOLL & SADLO CARDIOLOGY PLLC

Table of content: DR. JOHN ERIC FROYD PH.D. (NPI 1386942209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346371879 NPI number — SHUGOLL & SADLO CARDIOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHUGOLL & SADLO CARDIOLOGY 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:
1346371879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4736 RELIABLE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60686-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-629-3838
Provider Business Mailing Address Fax Number:
502-629-3833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 EAST GRAY STREET
Provider Second Line Business Practice Location Address:
SUITE 554
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-3838
Provider Business Practice Location Address Fax Number:
502-629-3833
Provider Enumeration Date:
03/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHUGOLL
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN AND OWNER
Authorized Official Telephone Number:
502-629-3838

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200879140A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100000930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG0273 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".