1962472951 NPI number — TERRY M MCCURRY JR. MD

Table of content: TERRY M MCCURRY JR. MD (NPI 1962472951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962472951 NPI number — TERRY M MCCURRY JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCURRY
Provider First Name:
TERRY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1962472951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 710
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-583-8303
Provider Business Mailing Address Fax Number:
502-584-0302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 710
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-583-8303
Provider Business Practice Location Address Fax Number:
502-584-0302
Provider Enumeration Date:
01/24/2006

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: 208600000X , with the licence number:  33045 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 33045 , 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: 200429060 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64063274 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50000932 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".