1396883260 NPI number — AUDIOLOGY PARTNERS

Table of content: (NPI 1396883260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396883260 NPI number — AUDIOLOGY PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDIOLOGY PARTNERS
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:
1396883260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAINTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41240-0677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-788-9304
Provider Business Mailing Address Fax Number:
606-788-9367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-788-9304
Provider Business Practice Location Address Fax Number:
606-788-9367
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
M.D
Authorized Official Telephone Number:
606-788-9304

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  33745 , 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: 000000111905 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64373459 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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