Healthcare Provider Details

I. General information

NPI: 1790123214
Provider Name (Legal Business Name): LINDE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 WILLOW AVE
FORT KNOX KY
40121-4512
US

IV. Provider business mailing address

218 WILLOW AVE
FORT KNOX KY
40121-4512
US

V. Phone/Fax

Practice location:
  • Phone: 502-378-0462
  • Fax:
Mailing address:
  • Phone: 502-378-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number740228
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2012020488
License Number StateTX

VIII. Authorized Official

Name: SHELLY RYAN
Title or Position: SENIOR CONSULTANT
Credential:
Phone: 866-863-2870