Basic Information
| Provider Information | |||||||||
| NPI: | 1720084262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALCOMBE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | LORNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028948441 | ||||||||
| FaxNumber: | 5028944453 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028948441 | ||||||||
| FaxNumber: | 5028944453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 08/23/2012 | ||||||||
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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 | 207Y00000X | 28985 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 64289853 | 05 | KY | MEDICAID | P00861077 | 01 | IN | MEDICARE RAILROAD- ICC | OTHER | 000000674386 | 01 | KY | ANTHEM - NICC | OTHER | 117555 | 01 | KY | SIHO - NICC | OTHER | 200024650 | 05 | IN | MEDICAID | 000000045106 | 01 | KY | BCBS | OTHER | 610731823 | 01 | TAX ID | OTHER | 61-0719349 | 01 | KY | TAX ID | OTHER | 7100199530 | 05 | KY | MEDICAID | P00861078 | 01 | KY | MEDICARE RAILROAD-ICC | OTHER |