MEDICARE: DR. KENNETH J PAYNE M.D.

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	207V00000X	Obstetrics & Gynecology Physician	40305	KY
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	40305	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00861080	OTHER	KY	RAILROAD MEDICARE- LUIS M. VELASCO, MD & ASSOC.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000641999	OTHER	KY	ANTHEM- LUIS M. VELASCO, MD & ASSOCIATES
2	000052152U	OTHER	KY	HUMANA- LUIS VELASCO, MD & ASSOCIATES
3	3760421000	OTHER	KY	PASSPORT ADVANTAGE- LUIS M. VELASCO, MD & ASSOC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	110222	OTHER	KY	SIHO- LUIS M. VELASCO, MD & ASSOC.
6	3738590	OTHER	KY	CIGNA- LUIS M. VELASCO, MD & ASSOC.
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	50027081	OTHER	KY	PASSPORT- LUIS M. VELASCO, MD & ASSOC.

General Provider Information

NPI Number	:	1518079649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J PAYNE M.D.

Provider Business Mailing Address
First Line	:	1104 SHADY LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2256
Country	:	US
Telephone Number	:	502-797-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 S FLOYD ST STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1837
Country	:	US
Telephone Number	:	502-629-1515
Fax Number	:	502-629-1545

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/22/2024

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