1083708341 NPI number — NARODA MEDICAL LLC

Table of content: (NPI 1083708341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083708341 NPI number — NARODA MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NARODA MEDICAL LLC
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:
1083708341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1071
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41702-1071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-487-8059
Provider Business Mailing Address Fax Number:
606-487-1658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 MORTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-9469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-436-5763
Provider Business Practice Location Address Fax Number:
606-436-0601
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHANDARANA
Authorized Official First Name:
JYOTIN
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
606-436-5763

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65945545 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".