1821133141 NPI number — COMMONWEALTH FAMILY PHYSICIANS PSC

Table of content: (NPI 1821133141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821133141 NPI number — COMMONWEALTH FAMILY PHYSICIANS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH FAMILY PHYSICIANS PSC
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:
1821133141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MONARCH ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40513-1899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-8421
Provider Business Mailing Address Fax Number:
859-278-1751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MONARCH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40513-1899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-278-8421
Provider Business Practice Location Address Fax Number:
859-278-1751
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
CALVIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-278-8421

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  02349 , 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: 7100244500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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