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  7. NPI Record 1750337440

CHARLES LEE MARCUM M.D.
Complete NPI Record 1750337440
Emergency Medicine in Corbin, KY


Quality Rating: 75 out of 100 score

NPI Status: Active since May 25, 2006

Contact Information

1 TRILLIUM WAY
CORBIN, KY
ZIP 40701
Phone: (606) 528-1212

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Provider Gender Code
  21. Healthcare Provider Taxonomy Code 1
  22. Provider License Number 1
  23. Provider License Number State Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Other Provider Identifier 1
  26. Other Provider Identifier Type Code 1
  27. Other Provider Identifier State 1
  28. Other Provider Identifier Issuer 1
  29. Other Provider Identifier 2
  30. Other Provider Identifier Type Code 2
  31. Other Provider Identifier State 2
  32. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1750337440. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750337440
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Entity Type Code: 1
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: CHARLES
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Middle Name: LEE
The city name in the location address of the provider being identified.
Provider Credential Text: M.D.
The State code in the location of the provider being identified.
Provider First Line Business Mailing Address: 284 ROSE HILL AVE
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Mailing Address City Name: VERSAILLES
The country code in the location address of the provider being identified.
Provider Business Mailing Address State Name: KY
The telephone number associated with the location address of the provider being identified.
Provider Business Mailing Address Postal Code: 403831224
The fax number associated with the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The date the provider was assigned a unique identifier (assigned an NPI).
Provider First Line Business Practice Location Address: 1 TRILLIUM WAY
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CORBIN
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: KY
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 407018426
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6065281212
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/25/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/8/2007
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207P00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 28918
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: KY
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 000000053343
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: KY
Other Provider Identifier Issuer 1: BLUE CROSS BLUE SHIELD
Other Provider Identifier 2: 64289184
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: KY
Is Sole Proprietor: X
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No