Basic Information
| Provider Information | |||||||||
| NPI: | 1275528739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNELL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725337 | ||||||||
| Practice Location | |||||||||
| Address1: | 3991 DUTCHMANS LN | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028996952 | ||||||||
| FaxNumber: | 5028999689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 02838 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 096990 | 01 | SIHO/NORTON | OTHER | P00626228 | 01 | KY | RAILROAD-NCMA | OTHER | 0000557851 | 01 | ANTHEM/NORTON | OTHER | 0413542 | 01 | CIGNA/NORTON | OTHER | 64079122 | 05 | KY | MEDICAID |