1659591485 NPI number — PETER KIONGO MHS,OTR

Table of content: PETER KIONGO MHS,OTR (NPI 1659591485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659591485 NPI number — PETER KIONGO MHS,OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIONGO
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHS,OTR
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:
1659591485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1362 W BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42066-1930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-727-1023
Provider Business Mailing Address Fax Number:
270-247-6669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 N 7TH ST
Provider Second Line Business Practice Location Address:
#16 ROOM 102
Provider Business Practice Location Address City Name:
MAYFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42066-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-727-1023
Provider Business Practice Location Address Fax Number:
270-247-6669
Provider Enumeration Date:
04/26/2007

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1718 . This is a "FIRST STEPS PROGRAM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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