Provider Demographics
| NPI: | 1114955093 |
|---|---|
| Name: | NORTON - KINGS DAUGHTERS HEALTH INC |
| Entity type: | Organization |
| Organization Name: | NORTON - KINGS DAUGHTERS HEALTH INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP, MANAGED CARE |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SHELLEY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GAST |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 502-303-2329 |
| Mailing Address - Street 1: | PO BOX 3395 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | EVANSVILLE |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 47732-3395 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 812-801-0715 |
| Mailing Address - Fax: | 812-265-6603 |
| Practice Address - Street 1: | 1373 E STATE ROAD 62 |
| Practice Address - Street 2: | |
| Practice Address - City: | MADISON |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 47250-7328 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 812-801-0800 |
| Practice Address - Fax: | 812-265-6603 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | NORTON - KINGS DAUGHTERS HEALTH INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-06-29 |
| Last Update Date: | 2024-08-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Multi-Specialty |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 65903890 | Medicaid | |
| KY | 78901048 | Medicaid | |
| IN | 100148960 | Medicaid | |
| KY | 65928533 | Medicaid | |
| IN | 200140910 | Medicaid | |
| IN | 000000056018 | Other | ANTHEM BCBS |
| IN | 100388910 | Medicaid | |
| KY | 1170897 | Other | PASSPORT MEDICAID |
| IN | 000000056018 | Other | ANTHEM BCBS |
| KY | 1170897 | Other | PASSPORT MEDICAID |
| KY | 78901048 | Medicaid | |
| IN | 701910 | Medicare PIN | |
| KY | 06005 | Medicare PIN | |
| IN | 200140910 | Medicaid | |
| KY | 65928533 | Medicaid | |
| IN | 412920 | Medicare PIN | |
| IN | 412850 | Medicare PIN |
