Basic Information
| Provider Information | |||||||||
| NPI: | 1265416259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 OLYMPIA PARK PLZ | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024239595 | ||||||||
| FaxNumber: | 5027190161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 31256 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000044684 | 01 | KY | BCBS | OTHER | 50037682 | 01 | KY | PASSPORT - WOMEN'S SPECIALISTS | OTHER | 610679864F | 01 | KY | HUMANA | OTHER | 1058742 | 05 | KY | MEDICAID | 160029909 | 01 | KY | RR MEDICARE | OTHER | 134800 | 01 | KY | SIHO - WS | OTHER | 64312564 | 05 | KY | MEDICAID | 000000765748 | 01 | KY | ANTHEM - WS | OTHER | 50037682 | 01 | KY | PASSPORT - WS | OTHER |