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General NPI Number Information
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NPI Number | 1760667299
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Entity Type | Organization
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Legal Business Name | HEPATITIS C TREATMENT CENTERS INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 1009 N DUPONT SQ
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City | LOUISVILLE
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State | KY
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Zip | 40207-4612
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Country | US
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Telephone | 502-721-5220
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Fax | 502-894-9991
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Provider Business Mailing Address
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Address Line | PO BOX 384
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City | PROSPECT
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State | KY
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Zip | 40059-0384
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Country | US
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Telephone | 502-894-9951
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Fax | 502-225-5858
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LORI DIANE BOND
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Credential | MS
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Telephone | 502-727-8268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | KY21721
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License Number State | KY
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