Healthcare Provider Details

I. General information

NPI: 1306635297
Provider Name (Legal Business Name): KENTUCKY CENTER FOR ADVANCED NEUROMODULATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 LYNDON CENTRE WAY STE 202
LOUISVILLE KY
40222-3604
US

IV. Provider business mailing address

8003 LYNDON CENTRE WAY STE 202
LOUISVILLE KY
40222-3604
US

V. Phone/Fax

Practice location:
  • Phone: 502-327-7701
  • Fax: 502-327-7705
Mailing address:
  • Phone: 502-327-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE SCHRODT
Title or Position: OWNER
Credential:
Phone: 502-327-7701