Healthcare Provider Details

I. General information

NPI: 1821270653
Provider Name (Legal Business Name): ALLCARE MEDICAL CENTERS OF KENTUCKIANA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3934 DIXIE HWY STE 346
LOUISVILLE KY
40216-4163
US

IV. Provider business mailing address

3934 DIXIE HWY STE 346
LOUISVILLE KY
40216-4163
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-5455
  • Fax: 502-447-5499
Mailing address:
  • Phone: 502-447-5455
  • Fax: 502-447-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39534
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35781
License Number StateKY

VIII. Authorized Official

Name: DR. CHRIS KOFORD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 502-447-5455