1821285727 NPI number — DR. ERICH L ERNSPIKER M.D.

Table of content: DR. ERICH L ERNSPIKER M.D. (NPI 1821285727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821285727 NPI number — DR. ERICH L ERNSPIKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERNSPIKER
Provider First Name:
ERICH
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
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:
1821285727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 432
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41502-0432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-430-2202
Provider Business Mailing Address Fax Number:
606-218-7502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 VIRGINIA AVE NE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24273-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-679-2310
Provider Business Practice Location Address Fax Number:
276-679-8460
Provider Enumeration Date:
09/25/2007

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: 208600000X , with the licence number:  42548 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 0101254580 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 622640 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65930364 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100078780 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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