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NPI Code Detail

MEDICARE: ADAS

MEDICARE: ADAS
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
1207Q00000XFamily Medicine Physician35817KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000259494OTHERKYBCBS
3000000259494OTHERKYANTHEM

General Provider Information

NPI Number : 1548476948
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADAS
Provider Business Mailing Address
First Line : 1704 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8137
Country : US
Telephone Number : 270-432-4800
Fax Number : 270-432-4804
Provider Business Practice Location Address
First Line : 1704 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8137
Country : US
Telephone Number : 270-432-4800
Fax Number : 270-432-4804
Authorized Official
Title or Position : OWNER
Name : DR. JOHN W DRURY
Credential : MD
Telephone Number : 270-432-4800
Provider Enumeration Date : 05/15/2007
Last Update Date : 08/22/2020

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Directions to “ADAS ” Practice Location

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