1992047179 NPI number — PREMIER INTEGRITY SOLUTIONS INC

Table of content: (NPI 1992047179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992047179 NPI number — PREMIER INTEGRITY SOLUTIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER INTEGRITY SOLUTIONS INC
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:
1992047179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2279
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELL SPRINGS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42642-2279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-866-3762
Provider Business Mailing Address Fax Number:
270-866-3793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 LAKEWAY DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RUSSELL SPRINGS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42642-4179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-866-3762
Provider Business Practice Location Address Fax Number:
270-866-3793
Provider Enumeration Date:
03/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RAGLE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
270-866-3144

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  200344 , 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: 3810026106 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0158089 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100245710 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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