Healthcare Provider Details

I. General information

NPI: 1023084092
Provider Name (Legal Business Name): HOLLIS R HILTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE ROAD
LEXINGTON KY
40503
US

IV. Provider business mailing address

PO BOX 1827
LEXINGTON KY
40588
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-6180
  • Fax: 859-260-6693
Mailing address:
  • Phone: 859-277-8179
  • Fax: 859-277-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberKY25943
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: