1689874885 NPI number — NGOC DO-BIZZELL OD, PSC

Table of content: (NPI 1689874885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689874885 NPI number — NGOC DO-BIZZELL OD, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NGOC DO-BIZZELL OD, PSC
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:
1689874885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 NEW MOODY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-9142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-222-2889
Provider Business Mailing Address Fax Number:
502-222-5274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 NEW MOODY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-2889
Provider Business Practice Location Address Fax Number:
844-305-1011
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DO-BIZZELL
Authorized Official First Name:
NGOC
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
502-222-2889

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1582DTKY , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 77001022 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215006770 . This is a "NPI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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