1316072432 NPI number — KENTUCKY URGENT TREATMENT ASSOCIATES, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316072432 NPI number — KENTUCKY URGENT TREATMENT ASSOCIATES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY URGENT TREATMENT ASSOCIATES, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NICHOLASVILLE URGENT TREATMENT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316072432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3174 CUSTER DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-273-8882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 BELLAIRE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICHOLASVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40356-8840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-887-4882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-273-8882

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65946105 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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