Healthcare Provider Details

I. General information

NPI: 1043339708
Provider Name (Legal Business Name): ULRICH MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E HIGHWAY 3094
EAST BERNSTADT KY
40729-6216
US

IV. Provider business mailing address

1655 EAST HWY 3094 PO BOX 328
EAST BERNSTADT KY
40729
US

V. Phone/Fax

Practice location:
  • Phone: 606-843-2339
  • Fax: 606-843-6815
Mailing address:
  • Phone: 606-843-2339
  • Fax: 606-843-6815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS ANDRE ULRICH
Title or Position: OWNER
Credential: M.D.
Phone: 606-843-2339