1942629472 NPI number — CENTRAL KENTUCKY KIDNEY CENTER LLC

Table of content: (NPI 1942629472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942629472 NPI number — CENTRAL KENTUCKY KIDNEY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL KENTUCKY KIDNEY CENTER LLC
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:
1942629472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 CHURCH ST
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-2990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-327-3061
Provider Business Mailing Address Fax Number:
615-329-2513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 DANIEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-236-6300
Provider Business Practice Location Address Fax Number:
859-236-6307
Provider Enumeration Date:
04/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ATTRILL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-327-3061

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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