1548523376 NPI number — E & R ENTERPRISES, P.L.L.C.

Table of content: (NPI 1548523376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548523376 NPI number — E & R ENTERPRISES, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E & R ENTERPRISES, P.L.L.C.
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:
6
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:
1548523376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 W LOWRY LN STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
185-926-3808
Provider Business Mailing Address Fax Number:
859-263-8775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3217 SUMMIT SQUARE PL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-263-8080
Provider Business Practice Location Address Fax Number:
859-263-8775
Provider Enumeration Date:
06/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PAVKOVICH
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
859-619-5808

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT005087 , 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)





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