Healthcare Provider Details

I. General information

NPI: 1174967269
Provider Name (Legal Business Name): UNIVERSITY OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S LIMESTONE ST PAVILLION A.01.114
LEXINGTON KY
40536-0294
US

IV. Provider business mailing address

740 S LIMESTONE ROOM J134 KENTUCKY CLINIC
LEXINGTON KY
40536-0294
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-3340
  • Fax: 859-323-4277
Mailing address:
  • Phone: 859-323-5855
  • Fax: 859-323-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07556
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberP07556
License Number StateKY

VIII. Authorized Official

Name: ELAINE DEBORD YOUNCE
Title or Position: CHIEF OF PAYER ADMINISTRATION
Credential: FHFMA
Phone: 859-257-9521