=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073609731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF KENTUCKY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 S LIMESTONE FIRST FLOOR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40536-0284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-323-5855
-----------------------------------------------------
Fax | 859-257-3828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 S LIMESTONE FIRST FLOOR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40536-0284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-323-5855
-----------------------------------------------------
Fax | 859-257-3828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF PAYER ADMINISTRATION
-----------------------------------------------------
Name | ELAINE DEBORD YOUNCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-257-9521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | P01621
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | P01621
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | P01621
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------