1740286921 NPI number — DR. WILLIAM R ALLEN MD

Table of content: DR. WILLIAM R ALLEN MD (NPI 1740286921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740286921 NPI number — DR. WILLIAM R ALLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
WILLIAM
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1740286921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
793 EASTERN BYP
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40475-2422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-626-8645
Provider Business Mailing Address Fax Number:
859-626-8661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4071 TATES CREEK CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-3062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-971-4695
Provider Business Practice Location Address Fax Number:
859-971-4604
Provider Enumeration Date:
06/22/2005

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: 208800000X , with the licence number:  20000 , 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: 64200009 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: K191130 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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