Basic Information
| Provider Information | |||||||||
| NPI: | 1023050549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNEYCUTT | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 870 CORPORATE DR | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405035416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592779436 | ||||||||
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| Practice Location | |||||||||
| Address1: | 549 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405081612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592779436 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 37413 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD2013-0305 | NM | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 37413 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64069305 | 05 | KY | MEDICAID | 0111228 | 05 | OH | MEDICAID | P00479644 | 01 | KY | MEDICARE RAILROAD | OTHER |