Healthcare Provider Details

I. General information

NPI: 1508726035
Provider Name (Legal Business Name): OLDHAM COUNTY EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 NEW MOODY LN
LA GRANGE KY
40031-9154
US

IV. Provider business mailing address

PO BOX 42486
BELFAST ME
04915-1276
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-5388
  • Fax:
Mailing address:
  • Phone: 770-874-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KIM LARSEN
Title or Position: VP , CREDENTIALING
Credential:
Phone: 770-874-5400