1659377950 NPI number — DR. MITCHELL CARL MD

Table of content: DR. MITCHELL CARL MD (NPI 1659377950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659377950 NPI number — DR. MITCHELL CARL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARL
Provider First Name:
MITCHELL
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1659377950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 TECHWOOD DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-8500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-936-9844
Provider Business Mailing Address Fax Number:
859-238-2206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TRILLIUM WAY
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-8426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-5000
Provider Business Practice Location Address Fax Number:
606-528-5113
Provider Enumeration Date:
06/22/2005

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: 207RH0003X , with the licence number:  37722 , 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: 611277847 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64062292 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830008709 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000769615 . This is a "BCBS TROVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01079962 . This is a "RR MEDICARE TROVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7525437 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: H61953 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000290035 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 500000606 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 023379600 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611277847C . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611277847 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 87105 . This is a "COVENTRYCARES OF KENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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