Basic Information
| Provider Information | |||||||||
| NPI: | 1699772335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EADE | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 KINGSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704653812 | ||||||||
| FaxNumber: | 2704658352 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 KINGSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704653812 | ||||||||
| FaxNumber: | 2704658352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22151 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | AE1715830 | 01 | DEA | OTHER | 0989814 | 01 | MEDICARE HOSPITAL | OTHER | 000000049741 | 01 | KY | BC/BS | OTHER | 64221518 | 05 | KY | MEDICAID |