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General NPI Number Information
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NPI Number | 1356641757
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Entity Type | Organization
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Legal Business Name | GOLDENROD HEALTH CORP
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1555 E NEW CIRCLE RD STE 142-214
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City | LEXINGTON
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State | KY
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Zip | 40509-1043
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Country | US
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Telephone | 859-539-6487
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 E NEW CIRCLE RD STE 142-214
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City | LEXINGTON
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State | KY
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Zip | 40509-1043
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Country | US
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Telephone | 859-539-6487
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BOBY G THECKEDATH
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Credential |
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Telephone | 859-539-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 38387
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License Number State | KY
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