Basic Information
| Provider Information | |||||||||
| NPI: | 1386934354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF KENTUCKY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | MN 150 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592575548 | ||||||||
| FaxNumber: | 8592575549 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | MN 150 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592575548 | ||||||||
| FaxNumber: | 8592575549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | BLAIR | ||||||||
| AuthorizedOfficialFirstName: | KARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FACULTY RECRUITMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8593235962 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 3006742 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 01013978 | 05 | KY | MEDICAID |