1417001629 NPI number — AFTER HOUR CARE OF KENTUCKIANA, INC.

Table of content: (NPI 1417001629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417001629 NPI number — AFTER HOUR CARE OF KENTUCKIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFTER HOUR CARE OF KENTUCKIANA, INC.
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:
6
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:
1417001629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10216 TAYLORSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 500B
Provider Business Mailing Address City Name:
JEFFERSONTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40299-3616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-297-8900
Provider Business Mailing Address Fax Number:
502-240-5654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10216 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 500B
Provider Business Practice Location Address City Name:
JEFFERSONTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40299-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-297-8900
Provider Business Practice Location Address Fax Number:
502-240-5654
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
CLARENCE
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
CHAIRMAN & CEO
Authorized Official Telephone Number:
502-297-8900

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  0486610 , 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: 50009143 . This is a "PASSPORT- CENTRAL STATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65944738 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50008530 . This is a "PASSPORT-JTOWN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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