1093895526 NPI number — KENTUCKY HAND CENTER PSC

Table of content: (NPI 1093895526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093895526 NPI number — KENTUCKY HAND CENTER PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY HAND CENTER 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:
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:
1093895526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 SHAKER DR
Provider Second Line Business Mailing Address:
SUITE #104
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-9546
Provider Business Mailing Address Fax Number:
859-277-8512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 SHAKER DR
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-278-9546
Provider Business Practice Location Address Fax Number:
859-277-8512
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMBS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-278-9546

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  15480 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2086S0105X , with the licence number: 15480 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 00000045917 . This is a "BLUE CROSS ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64154800 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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