MEDICARE: WILLIAM C ALLEN 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	207L00000X	Anesthesiology Physician	18917	KY
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	18917	KY

General Provider Information

NPI Number	:	1639125404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM C ALLEN M.D.

Provider Business Mailing Address
First Line	:	1145 W LEXINGTON AVE STE C
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1290
Country	:	US
Telephone Number	:	859-385-4093
Fax Number	:	859-355-4058

Provider Business Practice Location Address
First Line	:	112 W HIGH ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40507-1826
Country	:	US
Telephone Number	:	859-523-3009
Fax Number	:	859-523-5007

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/22/2023

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