1881697464 NPI number — CLINICAL ASSOCIATES, LLC

Table of content: (NPI 1881697464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881697464 NPI number — CLINICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL ASSOCIATES, LLC
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:
CPA LAB
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:
1881697464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 538359
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30353-8359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-897-9594
Provider Business Mailing Address Fax Number:
502-896-1808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2935 BRECKENRIDGE LN STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40220-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-9594
Provider Business Practice Location Address Fax Number:
502-896-1808
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROWAN
Authorized Official First Name:
DIANNE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR FINANCE BILLING
Authorized Official Telephone Number:
502-897-9594

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  200291 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 200291 , 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: 000000061989 . This is a "ANTHEM WELLPOINT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65908972 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1049047 . This is a "PASSPORT KY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 020379400 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2432349000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100009130 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000058863 . This is a "ANTHEM - - BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 163387800 . This is a "FECA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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