MEDICARE: VINNA DENISON HUMPHRIES MD 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
1	207Q00000X	Family Medicine Physician

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

General Provider Information

NPI Number	:	1720002371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINNA DENISON HUMPHRIES MD LLC

Provider Business Mailing Address
First Line	:	320 NORTH DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-1806
Country	:	US
Telephone Number	:	270-707-0303
Fax Number	:	270-707-0808

Provider Business Practice Location Address
First Line	:	320 NORTH DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-1806
Country	:	US
Telephone Number	:	270-707-0303
Fax Number	:	270-707-0808

Authorized Official
Title or Position	:	OWNER
Name	:	VINNA D HUMPHRIES
Credential	:	MD
Telephone Number	:	270-707-0303

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/30/2007

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