1437514346 NPI number — TINA F SIMPSON MD PLLC

Table of content: (NPI 1437514346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437514346 NPI number — TINA F SIMPSON MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TINA F SIMPSON MD 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:
1437514346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 CLUB LN
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:
40207-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8442 DIXIE HWY
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:
40258-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-565-4355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
502-593-2494

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  31256 , 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)