1548355688 NPI number — UROLOGY PARTNERS OF WESTERN KY, PSC

Table of content: (NPI 1548355688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548355688 NPI number — UROLOGY PARTNERS OF WESTERN KY, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY PARTNERS OF WESTERN KY, PSC
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:
1548355688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1062
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42419-1062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-827-2915
Provider Business Mailing Address Fax Number:
270-643-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 MCCOY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-2867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-825-0020
Provider Business Practice Location Address Fax Number:
270-643-0082
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FELLOWS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
270-827-2915

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  24878 , 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: 64757602 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com