PHIL JAMES NYDEREK SR. (NPI# 1194984443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194984443 |
| Entity Type | Individual |
| Full Name | PHIL JAMES NYDEREK SR. |
| Practice Address |
103 Ashmoore Drive Greenup KY 41144 |
| Practice Telephone | 7408216973 |
| Practice Fax Number | 6064731389 |
| Mailing Telephone | 7408216973 |
| Mailing Fax Number | 6064731389 |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2015-05-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171WH0202X |
Contractor Specialization: Home Modifications |
Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2778632 | 05 |
| Street Address |
103 ASHMOORE DRIVE |
| City | GREENUP |
| State | KY |
| Zip Code | 41144 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902395528 | Whitney Nacole Rowe | Registered Nurse | Kings Daughters Medical Center Greenup Primary Care, 1629 Ashland Rd, Greenup, KY 41144 | 2018-05-09 |
| 1750552592 | Julie Ann Hines | Massage Therapist | 1629 Ashland Road, Suite 4, Greenup, KY 41144 | 2008-03-20 |
| 1922028737 | Misty Lynn Walter | Social Worker | 57 Dora Lane, Greenup, KY 41144 | 2006-07-21 |
| 1053814541 | Sarah Bowling-cameron | Counselor | 57 Dora Ln, Greenup, KY 41144 | 2018-03-12 |
| 1356795124 | Keishta Slatery | Counselor | 57 Dora Lane, Greenup, KY 41144 | 2016-04-19 |
| 1649618778 | Bellefonte Physician Services, Inc. | Nurse Practitioner | 1629 Ashland Rd, Greenup, KY 41144 | 2013-06-11 |
| 1821300328 | Michelle A. Aylsworth | Counselor | 57 Dora Ln, Greenup, KY 41144 | 2010-07-13 |
| 1043350978 | Linda Handy | Counselor | 57 Dora Ln, Greenup, KY 41144 | 2007-02-08 |
| 1144327610 | Gary Wagoner | Counselor | 57 Dora Lane, Greenup, KY 41144 | 2006-09-19 |
| 1215168562 | Carla Elizabeth Maye | Occupational Therapy Assistant | 404 Harrison St, Greenup, KY 41144-1016 | 2009-08-05 |
| Find all providers in zip 41144 | ||||
| Taxonomy Code | 171WH0202X |
| Grouping | Other Service Providers |
| Classification | Contractor |
| Specialization | Home Modifications |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366801383 | Sheritha Bousso | Contractor | 3220 Commander Dr, #203, Louisville, KY 40220-1776 | 2016-02-18 |
| 1548559818 | Michael D Blakey | Contractor | 12021 Ancient Spring Dr, Louisville, KY 40245-1803 | 2011-04-07 |
| 1376705954 | Christina Joy Etheridge | Contractor | 127 Tara Ct, Benton, KY 42025-7513 | 2008-06-25 |
| 1659970788 | Chasity Lanham | Contractor | 1001 Springside Way, Louisville, KY 40223-3782 | 2020-10-20 |
Please comment or provide details below to improve the information on PHIL JAMES NYDEREK SR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.