MEDICARE: MCE EMERGENCY PHYSICIANS, PLLC

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	207P00000X	Emergency Medicine Physician		KY

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	000000275811	OTHER	KY	BCBS OF KY 12 DIGIT GROUP
3	50000548	OTHER	KY	PASSPORT HEALTH GROUP #

General Provider Information

NPI Number	:	1629073325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCE EMERGENCY PHYSICIANS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3571
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-3571
Country	:	US
Telephone Number	:	800-476-8646
Fax Number	:	919-382-3210

Provider Business Practice Location Address
First Line	:	3920 DUTCHMANS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4702
Country	:	US
Telephone Number	:	502-259-6005
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. BRENDEN M WETHERTON
Credential	:	MD
Telephone Number	:	502-454-4274

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/21/2022

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