NPIMap

Organization Active NPI

Dr.Kenbroshddspc

  • Point of Service
  • Mascoutah, IL
National Provider Identifier
1134399421
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
019019341 Issued in IL
Legal business name
DR.KENBROSHDDSPC
Practice address
1180 N 6TH St
Mascoutah, IL 62258-1178
Phone
(618) 566-7000
Fax
(618) 566-7000
NPI assigned
Mar 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ken Neal Brosh, DDS
Title
Pres.
Phone
(618) 566-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 019019341 IL Primary

Addresses

Primary practice location

1180 N 6TH St
Mascoutah, IL 62258-1178

Mailing address

1180 N 6TH St
Mascoutah, IL 62258-1178
Phone (618) 566-7000

National Provider Directory

National Provider Directory

Locations

1180 N 6th St
Mascoutah, IL 62258
Phone (618) 566-7000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1134399421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 N 6TH ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622581178",
            "telephone_number": "618-566-7000",
            "fax_number": "618-566-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 N 6TH ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622581178",
            "telephone_number": "618-566-7000",
            "fax_number": "618-566-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR.KENBROSHDDSPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "BROSH",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "NEAL",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "618-566-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "IL",
            "license": "019019341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mascoutah, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.