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NPI Code Detail

MEDICARE: KND DEVELOPMENT 59 LLC

MEDICARE: KND DEVELOPMENT 59 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
1208M00000XHospitalist Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DL118BOTHERFLMEDICARE

General Provider Information

NPI Number : 1417286477
Entity Type Code : Organization
Provider Name (Legal Business Name) : KND DEVELOPMENT 59 LLC
Provider Business Mailing Address
First Line : 680 S 4TH ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-2407
Country : US
Telephone Number : 502-596-7358
Fax Number : 833-501-9731
Provider Business Practice Location Address
First Line : 5555 W BLUE HERON BLVD
Second Line :
City : RIVIERA BEACH
State : FL
Zip : 33418-7813
Country : US
Telephone Number : 561-840-0754
Fax Number : 502-596-4150
Authorized Official
Title or Position : DVP REVENUE CYCLE
Name : LINDA L FISHER
Credential :
Telephone Number : 502-596-7358
Provider Enumeration Date : 12/21/2009
Last Update Date : 07/01/2020

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