MEDICARE: KENTUCKY RIVER PHYSICIAN CORPORATION

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
1	261QP2300X	Primary Care Clinic/Center	700199	KY

General Provider Information

NPI Number	:	1831411354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY RIVER PHYSICIAN CORPORATION

Provider Business Mailing Address
First Line	:	1573 MALLORY LN STE 100
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2895
Country	:	US
Telephone Number	:	152-221-1400
Fax Number	:	615-465-3007

Provider Business Practice Location Address
First Line	:	726 HIGHWAY 15 N
Second Line	:	SUITE 4
City	:	JACKSON
State	:	KY
Zip	:	41339-8601
Country	:	US
Telephone Number	:	606-666-2545
Fax Number	:	606-666-2621

Authorized Official
Title or Position	:	SR. DIRECTOR PHYSICIAN REV CYCLE
Name	:	LAURA J FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	07/07/2023

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