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General NPI Number Information
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NPI Number | 1922001833
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Entity Type | Organization
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Legal Business Name | COLORECTAL CARE OF NORTHERN KY, PLLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 2865 CHANCELLOR DR STE 215
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-3912
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Country | US
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Telephone | 859-341-9659
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Fax | 859-341-9659
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Provider Business Mailing Address
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Address Line | PO BOX 272
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City | BURLINGTON
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State | KY
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Zip | 41005-0272
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Country | US
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Telephone | 513-891-2813
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Fax | 513-891-1039
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEAN R ADAMS
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Credential | MD
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Telephone | 859-341-9659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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