Healthcare Provider Details

I. General information

NPI: 1902214448
Provider Name (Legal Business Name): UK HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S LIMESTONE CTW 304
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

900 S LIMESTONE CTW 304
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-8178
  • Fax:
Mailing address:
  • Phone: 859-323-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES DOUGLAS BODINE JR.
Title or Position: RESIDENT PHYSICIAN
Credential: M.D.
Phone: 678-232-5211