MEDICARE: VINNA R DENISON MD

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
1	207Q00000X	Family Medicine Physician	21459	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080189899	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000246447	OTHER	KY	ANTHEM BCBS

General Provider Information

NPI Number	:	1366406258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINNA R DENISON MD

Provider Business Mailing Address
First Line	:	320 NORTH DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-1806
Country	:	US
Telephone Number	:	270-707-0303
Fax Number	:	270-707-0808

Provider Business Practice Location Address
First Line	:	320 NORTH DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-1806
Country	:	US
Telephone Number	:	270-707-0303
Fax Number	:	270-707-0808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	01/17/2017

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Directions to “ VINNA R DENISON MD” Practice Location

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