1831125780 NPI number — F. KEITH PAGE LMFT

Table of content: (NPI 1720402050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831125780 NPI number — F. KEITH PAGE LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGE
Provider First Name:
F. KEITH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1831125780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42304-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-684-7239
Provider Business Mailing Address Fax Number:
270-684-7239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 SAINT ANN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-4197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-684-7239
Provider Business Practice Location Address Fax Number:
270-684-7239
Provider Enumeration Date:
06/23/2006

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: 101YM0800X , with the licence number:  0419 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: KY 0419 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000389207 . This is a "ANTHEM PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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