1801148101 NPI number — DR. JOAN L KOGELSCHATZ, PHD

Table of content: (NPI 1801148101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801148101 NPI number — DR. JOAN L KOGELSCHATZ, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JOAN L KOGELSCHATZ, PHD
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:
1801148101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 HONEYSUCKLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-1934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-0719
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 HONEYSUCKLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-0719
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KOGELSCHATZ
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-794-0719

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW0647C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112273 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51041883 . This is a "BLLUE CROSS AND BLUE SHIELD PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000041883 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4381654 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111860 . This is a "COMPSYCH CORPORATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 511/01620 . This is a "MHCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103651 . This is a "TRICARE / VALUE OPTIONS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17982 . This is a "BEHAVIORAL HEALTH SYSTEMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3001795 . This is a "CERIDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 602389KOG . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120776000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1886 . This is a "AMERICAN BEHAVIORAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81870 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00397561 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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