Healthcare Provider Details

I. General information

NPI: 1720153935
Provider Name (Legal Business Name): KENTUCKY EMERGENCY ROOM PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HOPKINSVILLE ST
GREENVILLE KY
42345-1124
US

IV. Provider business mailing address

2950 ROBERTSON AVE
CINCINNATI OH
45209-1268
US

V. Phone/Fax

Practice location:
  • Phone: 800-513-3044
  • Fax: 513-281-4545
Mailing address:
  • Phone: 800-513-3044
  • Fax: 513-281-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLARD KEITH
Title or Position: CEO
Credential: MD
Phone: 270-338-8291