Healthcare Provider Details

I. General information

NPI: 1487989687
Provider Name (Legal Business Name): HEALTH SERVICES OF KENTUCKY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N WATTERSON TRL
LOUISVILLE KY
40243-2700
US

IV. Provider business mailing address

PO BOX 7766
LOUISVILLE KY
40257-0766
US

V. Phone/Fax

Practice location:
  • Phone: 502-314-7050
  • Fax: 502-245-5964
Mailing address:
  • Phone: 502-314-7050
  • Fax: 502-245-5964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4426P
License Number StateKY

VIII. Authorized Official

Name: MS. MARCIA LYNNE SHROCK
Title or Position: ONWER/PARTNER
Credential: ARNP
Phone: 502-314-7050