Basic Information
| Provider Information | |||||||||
| NPI: | 1053304139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRIS | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 HARRODSBURG RD | ||||||||
| Address2: | SUITE C215 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592789413 | ||||||||
| FaxNumber: | 8592766381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 HARRODSBURG RD | ||||||||
| Address2: | SUITE C215 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592789413 | ||||||||
| FaxNumber: | 8592766381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21397 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000047820 | 01 | KY | ANTHEM BLUE SHIELD | OTHER | 611012421 | 01 | KY | AETNA | OTHER | 611012421B | 01 | KY | HUMANA | OTHER | 0400543 | 01 | KY | UNITED HEALTHCARE | OTHER | 110056673 | 01 | KY | RAILROAD MEDICARE | OTHER | 1404232 | 01 | KY | UMWA | OTHER | 0400356 | 01 | KY | UNITED HEALTHCARE | OTHER | 61-1012421 | 01 | KY | TPN CONTRACTS | OTHER | 611012421 | 01 | KY | ESSENCE | OTHER | C68016 | 01 | KY | BLUEGRASS FAMILY HEALTH | OTHER | 0037677 | 01 | KY | MEDICARE - FAYETTE COUNTY HEALTH DEPARTMENT | OTHER | 1284109 | 01 | KY | UWMA | OTHER | 64-213978 | 05 | KY | MEDICAID |