1942305156 NPI number — SUSAN M. HODGE P.A.-C.

Table of content: SUSAN M. HODGE P.A.-C. (NPI 1942305156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942305156 NPI number — SUSAN M. HODGE P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODGE
Provider First Name:
SUSAN
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRATTON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942305156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 KNOX ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARBOURVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40906-1304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-546-6027
Provider Business Mailing Address Fax Number:
606-546-2084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 KNOX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-6027
Provider Business Practice Location Address Fax Number:
606-546-2084
Provider Enumeration Date:
09/13/2006

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: 363A00000X , with the licence number:  PA896 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: PA896 , 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: 7100120360 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01439763 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com