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General NPI Number Information
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NPI Number | 1922469261
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Entity Type | Organization
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Legal Business Name | DENNIS LEE NEWBERRY INC
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 1305 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2783
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Country | US
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Telephone | 270-827-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 4130 MIDDLE KNOTTSVILLE RD
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City | HAWESVILLE
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State | KY
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Zip | 42348-6603
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Country | US
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Telephone | 270-827-7100
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Fax |
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Authorized Official
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Title or Position | BILLING OFFICE MANAGER
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Name | MARK ANDREAS
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Credential |
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Telephone | 812-490-1822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 31736
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License Number State | KY
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