MEDICARE: VMD PRIMARY PROVIDERS CENTRAL KENTUCKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1063120194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VMD PRIMARY PROVIDERS CENTRAL KENTUCKY

Provider Business Mailing Address
First Line	:	4650 WESTWAY PARK BLVD STE 206
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W WALNUT ST STE 600
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1378
Country	:	US
Telephone Number	:	270-699-9500
Fax Number	:	270-699-9550

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE
Name	:	REBECCA RAGER
Credential	:
Telephone Number	:	844-969-0686

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	01/14/2025

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