1780078782 NPI number — ROWE GROUP LLC

Table of content: (NPI 1780078782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780078782 NPI number — ROWE GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROWE GROUP LLC
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:
1780078782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4845 KY ROUTE 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-9113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-889-8570
Provider Business Mailing Address Fax Number:
606-889-8572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 N LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-889-8570
Provider Business Practice Location Address Fax Number:
606-889-8572
Provider Enumeration Date:
03/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROWE
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
606-433-0555

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P07679 , 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: 2150998 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100348480 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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