1649349911 NPI number — TRI COUNTY OB GYN ASSOCIATES PLC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649349911 NPI number — TRI COUNTY OB GYN ASSOCIATES PLC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI COUNTY OB GYN ASSOCIATES PLC LLC
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:
1649349911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 NEW MOODY LN STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-9179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-222-5558
Provider Business Mailing Address Fax Number:
502-222-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 NEW MOODY LANE
Provider Second Line Business Practice Location Address:
TRI COUNTY OB GYN ASSOCIATES INC SUITE 103
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-5558
Provider Business Practice Location Address Fax Number:
502-222-3040
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPAULDING
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
STEWART
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
502-222-5558

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LW0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65935884 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2438489000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1149112 . This is a "AMERIHEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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