1548306665 NPI number — ANODON, INC

Table of content: (NPI 1548306665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548306665 NPI number — ANODON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANODON, 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:
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:
1548306665
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:
408 VIRGINIA AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-420-9911
Provider Business Mailing Address Fax Number:
502-420-9996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-420-9911
Provider Business Practice Location Address Fax Number:
502-420-9996
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AIREY
Authorized Official First Name:
DONA
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-420-9911

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  KY-638 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 174400000X , with the licence number: KY-1933 , 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: 208454 . This is a "COMPPSYCH INS." identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2136433 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 178865 . This is a "VALUE OPTIONS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1295732485 . This is a "NPI FOR DONA AIREY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000230216 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0578650000 . This is a "MAGELLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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