1700956869 NPI number — CHEST MEDICINE ASSOCIATES P.S.C.

Table of content: (NPI 1700956869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700956869 NPI number — CHEST MEDICINE ASSOCIATES P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEST MEDICINE ASSOCIATES P.S.C.
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:
6
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:
1700956869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3430 NEWBURG RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40218-2497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-238-3178
Provider Business Mailing Address Fax Number:
502-238-3653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4606 GREENWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40258-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-937-2209
Provider Business Practice Location Address Fax Number:
502-933-8714
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LACY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-455-0269

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1052030 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65934184 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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