1992833966 NPI number — REBECCA M. RABISH KCSA

Table of content: REBECCA M. RABISH KCSA (NPI 1992833966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992833966 NPI number — REBECCA M. RABISH KCSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RABISH
Provider First Name:
REBECCA
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
KCSA
Provider Gender Code:
F

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:
1992833966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 ABRAHAM FLEXNER WAY
Provider Second Line Business Mailing Address:
SUITE 1105
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-3841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-581-9223
Provider Business Mailing Address Fax Number:
502-581-9225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
SUITE 1105
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-581-9223
Provider Business Practice Location Address Fax Number:
502-581-9225
Provider Enumeration Date:
03/01/2007

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: 246ZS0410X , with the licence number:  SA142 , 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: 000000387279 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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