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NPI Code Detail

MEDICARE: KIOSK MEDICINE OF KENTUCKY LLC

MEDICARE: KIOSK MEDICINE OF KENTUCKY LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124549522
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIOSK MEDICINE OF KENTUCKY LLC
Provider Business Mailing Address
First Line : PO BOX 932958
Second Line :
City : CLEVELAND
State : OH
Zip : 44193-0028
Country : US
Telephone Number : 615-425-4200
Fax Number : 615-425-4201
Provider Business Practice Location Address
First Line : 9001 US HIGHWAY 42
Second Line :
City : UNION
State : KY
Zip : 41091-7191
Country : US
Telephone Number : 859-334-9430
Fax Number : 859-334-9431
Authorized Official
Title or Position : VP & GENERAL MANAGER
Name : MR. THOMAS SHELLY
Credential :
Telephone Number : 615-425-4200
Provider Enumeration Date : 07/06/2017
Last Update Date : 10/21/2025

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Directions to “KIOSK MEDICINE OF KENTUCKY LLC ” Practice Location

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