Healthcare Provider Details

I. General information

NPI: 1932384468
Provider Name (Legal Business Name): HEPATITIS C TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009A N DUPONT SQ
LOUISVILLE KY
40207-4612
US

IV. Provider business mailing address

PO BOX 384
PROSPECT KY
40059-0384
US

V. Phone/Fax

Practice location:
  • Phone: 502-894-9951
  • Fax: 502-894-9991
Mailing address:
  • Phone: 502-225-5214
  • Fax: 502-225-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO6887
License Number StateKY

VIII. Authorized Official

Name: BENNET DOWNS CECIL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 502-721-5220