Healthcare Provider Details

I. General information

NPI: 1952481905
Provider Name (Legal Business Name): CENTRAL KENTUCKY WOMEN'S HEALTHCARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

1158 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-6444
  • Fax: 502-863-6334
Mailing address:
  • Phone: 502-863-6444
  • Fax: 502-863-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25340
License Number StateKY

VIII. Authorized Official

Name: DR. ROBERT C. TRENT
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 502-863-6444