1689865362 NPI number — AMSOL ANESTHETISTS OF KENTUCKY PLLC

Table of content: (NPI 1689865362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689865362 NPI number — AMSOL ANESTHETISTS OF KENTUCKY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMSOL ANESTHETISTS OF KENTUCKY PLLC
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:
1689865362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10824
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35202-0824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-245-5525
Provider Business Mailing Address Fax Number:
717-653-8197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TRILLIUM WAY
Provider Second Line Business Practice Location Address:
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:
910-892-7161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILLIARD
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-892-7161

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C20398 . This is a "CUMBERLAND HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100027690 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000555566 . This is a "ANTHEM BLUE CROSS OF KENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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