Healthcare Provider Details

I. General information

NPI: 1194091645
Provider Name (Legal Business Name): KENTUCKY MEDICAL SERVICES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 BEVINS LN
GEORGETOWN KY
40324-6178
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9333
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRELL GRIFFITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-257-7910