1841397056 NPI number — FIRST YOU MEDICAL CENTER PLLC

Table of content: (NPI 1841397056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841397056 NPI number — FIRST YOU MEDICAL CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST YOU MEDICAL CENTER 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:
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:
1841397056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMINENCE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40019-0124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-593-0083
Provider Business Mailing Address Fax Number:
888-310-2675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 E BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMINENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40019-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-845-6288
Provider Business Practice Location Address Fax Number:
888-310-2675
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STIVERS DAVE
Authorized Official First Name:
SHANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER/OWNER
Authorized Official Telephone Number:
502-593-0083

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 900262 , 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: 1132401 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000184588 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CK7832 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100244840 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2437746001 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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