1669659660 NPI number — ALICIA C JOHNSON CSA

Table of content: ALICIA C JOHNSON CSA (NPI 1669659660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669659660 NPI number — ALICIA C JOHNSON CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ALICIA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSA
Provider Gender Code:
F

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:
1669659660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950248
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:
40295-0248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-253-1035
Provider Business Mailing Address Fax Number:
502-253-1037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 KRESGE WAY
Provider Second Line Business Practice Location Address:
SUITE 46
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-899-3858
Provider Business Practice Location Address Fax Number:
502-899-3878
Provider Enumeration Date:
01/22/2008

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: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SA187 . This is a "KENTUCKY MEDICAL LICENSURE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2389 . This is a "NAT'L SURGICAL ASST ASSOC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 86585 . This is a "NAT'L CERT SURG TECH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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