Healthcare Provider Details

I. General information

NPI: 1891112173
Provider Name (Legal Business Name): KENTUCKYONE HEALTH MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-0770
  • Fax: 606-864-1461
Mailing address:
  • Phone: 606-330-7844
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. CARMEL JONES
Title or Position: COO
Credential:
Phone: 859-313-1713