Healthcare Provider Details

I. General information

NPI: 1891984597
Provider Name (Legal Business Name): CENTRAL KENTUCKY HIGH RISK OBSTETRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N. EAGLE CREEK DRIVE SUITE 110
LEXINGTON KY
40509-1805
US

IV. Provider business mailing address

170 NORTH EAGLE CREEK DRIVE STE 110
LEXINGTON KY
40509-1805
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-0141
  • Fax: 859-263-8669
Mailing address:
  • Phone: 859-263-0141
  • Fax: 859-263-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BERRY CAMPBELL
Title or Position: OWNER
Credential: M.D.
Phone: 859-263-0141