1659420800 NPI number — HAROLD W. BLEVINS, M.D.,P.S.C.

Table of content: (NPI 1659420800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659420800 NPI number — HAROLD W. BLEVINS, M.D.,P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLD W. BLEVINS, M.D.,P.S.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:
1659420800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3999 DUTCHMANS LN STE 3A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-897-7300
Provider Business Mailing Address Fax Number:
502-897-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3999 DUTCHMANS LN STE 3A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-7300
Provider Business Practice Location Address Fax Number:
502-897-3332
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-897-7300

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200458400A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000057654 . This is a "UNICARE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1051605 . This is a "PASSPORT GROUP #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000057654 . This is a "ANTHEM GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CB3563 . This is a "R R MEDICARE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2433078000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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