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General NPI Number Information
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NPI Number | 1417001629
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Entity Type | Organization
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Legal Business Name | AFTER HOUR CARE OF KENTUCKIANA, INC.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10216 TAYLORSVILLE RD SUITE 500B
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-3616
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Country | US
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Telephone | 502-297-8900
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Fax | 502-240-5654
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Provider Business Mailing Address
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Address Line | 10216 TAYLORSVILLE RD SUITE 500B
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-3616
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Country | US
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Telephone | 502-297-8900
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Fax | 502-240-5654
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Authorized Official
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Title or Position | CHAIRMAN & CEO
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Name | DR. CLARENCE KENNETH PETERS
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Credential | M.D.
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Telephone | 502-297-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 0486610
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License Number State | KY
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