1538214853 NPI number — DR. OLLIE CHARLES DENNIS M. A., ED. D

Table of content: DR. OLLIE CHARLES DENNIS M. A., ED. D (NPI 1538214853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538214853 NPI number — DR. OLLIE CHARLES DENNIS M. A., ED. D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNIS
Provider First Name:
OLLIE
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. A., ED. D
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:
1538214853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 GLENVIEW DR
Provider Second Line Business Mailing Address:
SUITE-C
Provider Business Mailing Address City Name:
GLASGOW
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42141-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-651-2816
Provider Business Mailing Address Fax Number:
270-651-2816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 GLENVIEW DR
Provider Second Line Business Practice Location Address:
SUITE-C
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-651-2816
Provider Business Practice Location Address Fax Number:
270-651-2816
Provider Enumeration Date:
01/24/2007

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: 103TC0700X , with the licence number:  KY-100 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TS0200X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89001002 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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