1962621359 NPI number — MICHAEL K MCKINNEY DMD PSC

Table of content: (NPI 1962621359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962621359 NPI number — MICHAEL K MCKINNEY DMD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL K MCKINNEY DMD 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:
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:
1962621359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNIE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41651-0060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-377-0170
Provider Business Mailing Address Fax Number:
606-377-0179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JCT RT 680 & HWY 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNIE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-377-0170
Provider Business Practice Location Address Fax Number:
606-377-0179
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-377-0170

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6873 , 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: 60002698 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60068731 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61900163 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com