1811324494 NPI number — THOMPSON & CHOU CENTER FOR PHYSICAL

Table of content: (NPI 1811324494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811324494 NPI number — THOMPSON & CHOU CENTER FOR PHYSICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMPSON & CHOU CENTER FOR PHYSICAL
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:
1811324494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 43905
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:
40253-0905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-583-4700
Provider Business Mailing Address Fax Number:
502-583-8434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1931 WEST ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-583-4700
Provider Business Practice Location Address Fax Number:
502-583-8434
Provider Enumeration Date:
09/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHOU
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-583-4700

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  01045575 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 01047580 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 28184126A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 091290 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200207160A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65932410 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5622 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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