1558746602 NPI number — KENTUCKY FERTILITY ASSOCIATES, PLLC

Table of content: (NPI 1558746602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558746602 NPI number — KENTUCKY FERTILITY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY FERTILITY ASSOCIATES, PLLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1558746602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 MERIDIAN BLVD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-6667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-550-4922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4612 CHAMBERLAIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-1071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-550-4922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CABLE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF STRATEGY & PRODUCT OFFICER
Authorized Official Telephone Number:
615-550-4922

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  207VE0102X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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