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General NPI Number Information
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NPI Number | 1881765204
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Entity Type | Organization
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Legal Business Name | KENTUCKY NEPHROLOGY RESEARCH TRUST, INC.
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 1101 WINCHESTER RD SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40505-4028
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Country | US
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Telephone | 859-225-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 115 SAINT ANN ST
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City | OWENSBORO
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State | KY
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Zip | 42303-4145
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID MARSHALL
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Credential |
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Telephone | 270-684-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 300147
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 300147
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License Number State | KY
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