1952456683 NPI number — BRUCE H COYER PSC

Table of content: (NPI 1952456683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952456683 NPI number — BRUCE H COYER PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE H COYER PSC
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:
1952456683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 PASADENA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-2907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-276-4316
Provider Business Mailing Address Fax Number:
859-277-1867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 PASADENA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-276-4316
Provider Business Practice Location Address Fax Number:
859-277-1867
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COYER
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-276-4316

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  27546 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 17480 , 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: 65917288 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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