1770633307 NPI number — PHILLIP BRADLEY YUHAS D.C.

Table of content: PHILLIP BRADLEY YUHAS D.C. (NPI 1770633307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770633307 NPI number — PHILLIP BRADLEY YUHAS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YUHAS
Provider First Name:
PHILLIP
Provider Middle Name:
BRADLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1770633307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E JOHN ROWAN BLVD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
BARDSTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40004-2060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-331-0900
Provider Business Mailing Address Fax Number:
502-331-0937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E JOHN ROWAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
BARDSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40004-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-331-0900
Provider Business Practice Location Address Fax Number:
502-331-0937
Provider Enumeration Date:
01/12/2007

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: 111N00000X , with the licence number:  4592 , 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: 623955 . This is a "BLUEGRASS NETWORK" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1214298 . This is a "CHA HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4592 . This is a "STATE LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50004019 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CHOICE CARE . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 623955 . This is a "ACN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85002905 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000306600 . This is a "BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 17864897YUH . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 623955 . This is a "THE MAIL HANDLERS BENEFIT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2445411000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2445410000 . This is a "PASSPORT ADVANTAGE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7963456 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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