Basic Information
| Provider Information | |||||||||
| NPI: | 1548476948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JOHN W DRURY, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1704 W STOCKTON ST | ||||||||
| Address2: | |||||||||
| City: | EDMONTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421298137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704324800 | ||||||||
| FaxNumber: | 2704324804 | ||||||||
| Practice Location | |||||||||
| Address1: | 1704 W STOCKTON ST | ||||||||
| Address2: | |||||||||
| City: | EDMONTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421298137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704324800 | ||||||||
| FaxNumber: | 2704324804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DRURY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2704324800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35817 | KY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64026123 | 05 | KY | MEDICAID | 000000259494 | 01 | KY | BCBS | OTHER | 000000259494 | 01 | KY | ANTHEM | OTHER |