1215449590 NPI number — UNIVERSITY OF KENTUCKY

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 1215449590 NPI number — UNIVERSITY OF KENTUCKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF KENTUCKY
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:
Provider Other Organization Name Type Code:
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:
1215449590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 ROSE ST # D103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-5935
Provider Business Mailing Address Fax Number:
859-257-5859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UK COLLEGE OF DENTISTRY
Provider Second Line Business Practice Location Address:
770 ROSE STREET, MN328
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-3368
Provider Business Practice Location Address Fax Number:
859-257-5859
Provider Enumeration Date:
10/26/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIDDELL
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOC DEAN FINANCE ADMIN
Authorized Official Telephone Number:
859-323-5935

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X ; 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: "Y" .

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