1811020696 NPI number — MR. DARWIN KEITH EDWARDS M.D.

Table of content: (NPI 1356402051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811020696 NPI number — MR. DARWIN KEITH EDWARDS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
DARWIN
Provider Middle Name:
KEITH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811020696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 S PRESTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-589-1980
Provider Business Mailing Address Fax Number:
502-589-1982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 S PRESTON ST
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:
40202-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-1980
Provider Business Practice Location Address Fax Number:
502-589-1982
Provider Enumeration Date:
03/13/2007

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: 207ZP0101X , with the licence number:  18790 , 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: 1130651 . This is a "INDIVIDUAL AND GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000061816 . This is a "GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2433239000 . This is a "INDIVIDUAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 37000130 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054003 . This is a "INDIVIDUAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000062006 . This is a "INDIVIDUAL AND GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2433194000 . This is a "GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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