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NPI Code Detail

MEDICARE: CENTRAL KENTUCKY KIDNEY CARE LLC

MEDICARE: CENTRAL KENTUCKY KIDNEY CARE 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
2363L00000XNurse Practitioner
3207RN0300XNephrology Physician

General Provider Information

NPI Number : 1588434393
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL KENTUCKY KIDNEY CARE LLC
Provider Business Mailing Address
First Line : 150 WAR ADMIRAL STE 4
Second Line :
City : DANVILLE
State : KY
Zip : 40422-8690
Country : US
Telephone Number : 859-236-6300
Fax Number :
Provider Business Practice Location Address
First Line : 150 WAR ADMIRAL STE 4
Second Line :
City : DANVILLE
State : KY
Zip : 40422-8690
Country : US
Telephone Number : 859-236-6300
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AYMAN GENEIDY
Credential :
Telephone Number : 859-236-6300
Provider Enumeration Date : 01/03/2024
Last Update Date : 09/27/2024

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Directions to “CENTRAL KENTUCKY KIDNEY CARE LLC ” Practice Location

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