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NPI Code Detail

MEDICARE: COLORECTAL CARE OF NORTHERN KY, PLLC

MEDICARE: COLORECTAL CARE OF NORTHERN KY, PLLC
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
1208C00000XColon & Rectal Surgery Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DD6452OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922001833
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLORECTAL CARE OF NORTHERN KY, PLLC
Provider Business Mailing Address
First Line : PO BOX 272
Second Line :
City : BURLINGTON
State : KY
Zip : 41005-0272
Country : US
Telephone Number : 513-891-2813
Fax Number : 513-891-1039
Provider Business Practice Location Address
First Line : 2865 CHANCELLOR DR
Second Line : STE 215
City : CRESTVIEW HILLS
State : KY
Zip : 41017-3912
Country : US
Telephone Number : 859-341-9659
Fax Number : 859-341-9659
Authorized Official
Title or Position : PRESIDENT
Name : DEAN R ADAMS
Credential : MD
Telephone Number : 859-341-9659
Provider Enumeration Date : 05/24/2005
Last Update Date : 08/11/2009

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1508849399 — CHARLES ALBERT CAVALLO M.D.
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1265415053 — BARRY ALLEN BROKAW M.D.
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Practice Fax: 859-578-4594
1215910013 — MARK H. DEIS M.D.
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1750364394 — CHRISTOPHER ANTHONY CUNHA M.D.
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1780668707 — KEVIN M REIDY M.D.
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Directions to “COLORECTAL CARE OF NORTHERN KY, PLLC ” Practice Location

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