Basic Information
Provider Information | |||||||||
NPI: | 1619500766 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CENTRAL KY ELECTROPHYSIOLOGY SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1004 LEAWOOD DR | ||||||||
Address2: |   | ||||||||
City: | FRANKFORT | ||||||||
State: | KY | ||||||||
PostalCode: | 406013349 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5022237403 | ||||||||
FaxNumber: | 5022235016 | ||||||||
Practice Location | |||||||||
Address1: | 1004 LEAWOOD DR | ||||||||
Address2: |   | ||||||||
City: | FRANKFORT | ||||||||
State: | KY | ||||||||
PostalCode: | 406013349 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5022237403 | ||||||||
FaxNumber: | 5022235016 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/18/2020 | ||||||||
LastUpdateDate: | 02/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NITZ | ||||||||
AuthorizedOfficialFirstName: | ARTHUR | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 5022237403 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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NPICertificationDate: | 02/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204R00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine |   |
No ID Information.