1528118213 NPI number — MR. PATRICK CHRISTOPHER MYERS PT, MS, OCS, COMT

Table of content: MR. PATRICK CHRISTOPHER MYERS PT, MS, OCS, COMT (NPI 1528118213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528118213 NPI number — MR. PATRICK CHRISTOPHER MYERS PT, MS, OCS, COMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
PATRICK
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, MS, OCS, COMT
Provider Gender Code:
M

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:
1528118213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47716-5629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-759-7451
Provider Business Mailing Address Fax Number:
812-759-7482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 S ENGLISH STATION RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40245-4160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-8830
Provider Business Practice Location Address Fax Number:
502-245-1146
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  004097 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 004097 , 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: 11537 . This is a "OCS CERTIFICATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000345889 . This is a "ANTHEM INDIVIDUAL NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: KY4097 . This is a "KY STATE LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000946561 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100391470 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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