1558324160 NPI number — MERLE L KENNEDY MD

Table of content: MERLE L KENNEDY MD (NPI 1558324160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558324160 NPI number — MERLE L KENNEDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
MERLE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1558324160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 N CLEVELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-9105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-839-2300
Provider Business Mailing Address Fax Number:
614-839-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 N CLEVELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43082-9105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-839-2300
Provider Business Practice Location Address Fax Number:
614-839-2301
Provider Enumeration Date:
04/07/2006

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: 207X00000X , with the licence number:  35047762K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0114X , with the licence number: 35047762K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 35047762K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000120033 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 09-00371 . This is a "UHC PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4066846 . This is a "AETNA PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: KE0731251 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 854875 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881292-002 . This is a "CIGNA PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1376868448 . This is a "MEDICARE DME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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