Basic Information
| Provider Information | |||||||||
| NPI: | 1114198454 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSICIAN EXPRESS CARE BILLING | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PHYSICIAN EXPRESS CARE BILLING ARNP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407418601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068773931 | ||||||||
| FaxNumber: | 6068773978 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 LONDON MOUNTAIN VIEW DR | ||||||||
| Address2: | STE 4 | ||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407416617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068781181 | ||||||||
| FaxNumber: | 6068773978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 03/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | REA | ||||||||
| AuthorizedOfficialFirstName: | KANDI | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6068773931 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHYSICIAN EXPRESS CARE BILLING | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.