Basic Information
| Provider Information | |||||||||
| NPI: | 1508123423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL KY HEARING CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 GREENBRIAR DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704653595 | ||||||||
| FaxNumber: | 8592594063 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 GREENBRIAR DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704653595 | ||||||||
| FaxNumber: | 8592594063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 04/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | LAWLESS | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8592277192 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | AU.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 117 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.