1508822925 NPI number — DR. VINCENT PAUL GENOVESE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508822925 NPI number — DR. VINCENT PAUL GENOVESE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GENOVESE

Provider First Name:

VINCENT

Provider Middle Name:

PAUL

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1508822925

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/02/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 23229

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

OWENSBORO

Provider Business Mailing Address State Name:

KY

Provider Business Mailing Address Postal Code:

42304-3229

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

270-377-0111

Provider Business Mailing Address Fax Number:

270-377-0113

Provider First Line Business Practice Location Address:

440 HOPKINSVILLE ST

Provider Second Line Business Practice Location Address:

SUITE 2E

Provider Business Practice Location Address City Name:

GREENVILLE

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

42345-1124

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

270-377-0111

Provider Business Practice Location Address Fax Number:

270-377-0113

Provider Enumeration Date:

04/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  58998 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X , with the licence number: 40710 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000867 . This is a "BLUECHIP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 713792 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0901010 . This is a "UNITED HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 79983 . This is a "US HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: P0039857 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 3037843 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000508863 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 0119098-003 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 7100003760 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 17311 . This is a "PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".