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NPI Code Detail

MEDICARE: MATTHEW 25 AIDS SERVICES INC

MEDICARE: MATTHEW 25 AIDS SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor
3207Q00000XFamily Medicine Physician
4363A00000XPhysician Assistant
5363LF0000XFamily Nurse Practitioner
6261Q00000XClinic/Center740146KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
192-00380OTHERUNITED HEALTHCARE
2000000246990OTHERKYANTHEM KY & IN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
423130245OTHERKYPASSPORT HEALTH PLAN
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457355125
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATTHEW 25 AIDS SERVICES INC
Provider Business Mailing Address
First Line : 452 OLD CORYDON RD
Second Line :
City : HENDERSON
State : KY
Zip : 42420-4645
Country : US
Telephone Number : 270-826-0200
Fax Number : 270-826-0212
Provider Business Practice Location Address
First Line : 452 OLD CORYDON RD
Second Line :
City : HENDERSON
State : KY
Zip : 42420-4645
Country : US
Telephone Number : 270-826-0200
Fax Number : 270-826-0212
Authorized Official
Title or Position : CEO
Name : COURTNEY WOOLFORK
Credential :
Telephone Number : 270-826-0200
Provider Enumeration Date : 06/09/2005
Last Update Date : 01/16/2025

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Directions to “MATTHEW 25 AIDS SERVICES INC ” Practice Location

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