1679873400 NPI number — CAREMORE PAIN MANAGEMENT

Table of content: TAEJA KLUGE M.S., BCBA (NPI 1003246059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679873400 NPI number — CAREMORE PAIN MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMORE PAIN MANAGEMENT
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:
1679873400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 TEAYS BR
Provider Second Line Business Mailing Address:
PO BOX 443
Provider Business Mailing Address City Name:
PAINTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41240-8548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-789-7246
Provider Business Mailing Address Fax Number:
606-789-4392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 TEAYS BR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240-8548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-7246
Provider Business Practice Location Address Fax Number:
606-789-4392
Provider Enumeration Date:
10/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
GAYLA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
606-789-7246

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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