=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386933406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JRD DEVELOPMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2011
-----------------------------------------------------
Last Update Date | 03/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MEDICAL HEIGHTS DR SUITE H
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-223-5641
-----------------------------------------------------
Fax | 502-223-1047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 MEDICAL HEIGHTS DR SUITE F
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-875-1766
-----------------------------------------------------
Fax | 502-223-1047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. JULIE HOWARD THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-418-5775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------