1871666495 NPI number — KROGER LIMITED PARTNERSHIP I

Table of content: KAYLA ELIZABETH SLEDGE CRNP (NPI 1245816347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871666495 NPI number — KROGER LIMITED PARTNERSHIP I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KROGER LIMITED PARTNERSHIP I
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:
6
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:
1871666495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5960 CASTLEWAY WEST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-1977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-579-8434
Provider Business Mailing Address Fax Number:
317-579-8424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E BIDWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62568-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-287-7391
Provider Business Practice Location Address Fax Number:
217-287-7440
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MINEER
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERFACE MANAGER
Authorized Official Telephone Number:
513-387-7074

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054015081 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1476452 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".