Healthcare Provider Details

I. General information

NPI: 1417915661
Provider Name (Legal Business Name): KENTUCKY INPATIENT MEDICINE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR SAINT JOSEPH HOSPITAL,
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

5901-C PEACHTREE-DUNWOODY ROAD SUITE 350
ATLANTA GA
30328-7159
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-2963
  • Fax: 785-623-5045
Mailing address:
  • Phone: 678-441-8556
  • Fax: 678-441-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: TALBOT GREEN MCCORMICK III
Title or Position: PRESIDENT
Credential: MD
Phone: 678-441-8508