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General NPI Number Information
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NPI Number | 1417915661
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Entity Type | Organization
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Legal Business Name | KENTUCKY INPATIENT MEDICINE ASSOCIATES, PLLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 1 SAINT JOSEPH DR SAINT JOSEPH HOSPITAL,
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City | LEXINGTON
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State | KY
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Zip | 40504-3742
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Country | US
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Telephone | 859-313-2963
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Fax | 785-623-5045
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Provider Business Mailing Address
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Address Line | 5901-C PEACHTREE-DUNWOODY ROAD SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30328-7159
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Country | US
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Telephone | 678-441-8556
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Fax | 678-441-8656
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Authorized Official
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Title or Position | PRESIDENT
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Name | TALBOT GREEN MCCORMICK III
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Credential | MD
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Telephone | 678-441-8508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | KY
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Taxonomy #7
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State | KY
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