Healthcare Provider Details

I. General information

NPI: 1316634272
Provider Name (Legal Business Name): STAR MED OF KENTUCKY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4156 WESTPORT RD STE 214
LOUISVILLE KY
40207-2705
US

IV. Provider business mailing address

4156 WESTPORT RD STE 214
LOUISVILLE KY
40207-2705
US

V. Phone/Fax

Practice location:
  • Phone: 502-742-0012
  • Fax: 877-897-8103
Mailing address:
  • Phone: 502-742-0012
  • Fax: 877-897-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAYSHAWN HUNTER
Title or Position: OWNER
Credential: CMA
Phone: 859-309-8552