1841253424 NPI number — DOWNEY EYE CLINIC, PLLC

Table of content: (NPI 1841253424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841253424 NPI number — DOWNEY EYE CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOWNEY EYE CLINIC, PLLC
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:
DOWNEY EYE CLINIC
Provider Other Organization Name Type Code:
3
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:
1841253424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 BURKESVILLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42728-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-384-6043
Provider Business Mailing Address Fax Number:
270-384-0672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 BURKESVILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-384-6043
Provider Business Practice Location Address Fax Number:
270-384-0672
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
JACQUITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
270-384-6043

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  979DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 979DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X , with the licence number: KY0979DT , 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: 1689675159 . This is a "MAX M. DOWNEY IND. NPI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9801 . This is a "MEDICARE PTAN GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77904126 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00286828 . This is a "MEDICARE RAILROAD CARRIER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com