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General NPI Number Information
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NPI Number | 1306043401
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Entity Type | Organization
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Legal Business Name | BARDSTOWN INTERNAL MEDICINE, PSC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 810 MORTON AVE STE 202
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City | BARDSTOWN
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State | KY
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Zip | 40004-2549
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Country | US
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Telephone | 502-348-1990
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Fax | 502-348-1954
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Provider Business Mailing Address
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Address Line | 810 MORTON AVE STE 202
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City | BARDSTOWN
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State | KY
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Zip | 40004-2549
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Country | US
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Telephone | 502-348-1990
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Fax | 502-348-1954
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUSAN MEECE
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Credential |
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Telephone | 502-348-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 37944
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License Number State | KY
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