=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992122972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAPLAN, BARRON, ROTH, LEHOCKY & KATZ PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2014
-----------------------------------------------------
Last Update Date | 03/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 BARDSTOWN RD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40218-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-452-6337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 BARDSTOWN RD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40218-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JOHN ROTH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 502-452-6337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 16654
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------