Provider Demographics
NPI:1225361678
Name:JOHN E. COTTHOFF, M.D., PSC
Entity type:Organization
Organization Name:JOHN E. COTTHOFF, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:COTTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-885-1166
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0608
Mailing Address - Country:US
Mailing Address - Phone:270-885-1166
Mailing Address - Fax:270-885-2286
Practice Address - Street 1:200 STERLING DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1567
Practice Address - Country:US
Practice Address - Phone:270-885-1166
Practice Address - Fax:270-885-2286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN E. COTTHOFF, M.D., PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64111503Medicaid
KY64111503Medicaid
KY1255101Medicare PIN