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NPI Code Detail

MEDICARE: COMMONWEALTH OF KENTUCKY

MEDICARE: COMMONWEALTH OF KENTUCKY
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
1283Q00000XPsychiatric Hospital
23336I0012XInstitutional PharmacyP06579KY
3283Q00000XPsychiatric HospitalKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790816395
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMONWEALTH OF KENTUCKY
Provider Business Mailing Address
First Line : 1350 BULL LEA RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40511-1247
Country : US
Telephone Number : 859-246-8000
Fax Number : 859-246-8043
Provider Business Practice Location Address
First Line : 1350 BULL LEA RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40511-1247
Country : US
Telephone Number : 859-246-8000
Fax Number : 859-246-8043
Authorized Official
Title or Position : ASSISTANT DIRECTOR
Name : JENNIFER MOORE
Credential :
Telephone Number : 502-782-6117
Provider Enumeration Date : 03/08/2007
Last Update Date : 08/07/2024

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Directions to “COMMONWEALTH OF KENTUCKY ” Practice Location

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