1073609731 NPI number — UNIVERSITY OF KENTUCKY

Table of content: (NPI 1073609731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073609731 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:
6
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:
1073609731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 S LIMESTONE
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-5855
Provider Business Mailing Address Fax Number:
859-257-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 S LIMESTONE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-5855
Provider Business Practice Location Address Fax Number:
859-257-3828
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNCE
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
DEBORD
Authorized Official Title or Position:
CHIEF OF PAYER ADMINISTRATION
Authorized Official Telephone Number:
859-257-9521

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  P01621 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: P01621 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: P01621 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0001474002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45543592 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54008230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90870346 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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