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NPI Code Detail

MEDICARE: RELYMD MEDICAL GROUP KY, LLC

MEDICARE: RELYMD MEDICAL GROUP KY, 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11110355OTHERKYKENTUCKY SECRETARY OF STATE

General Provider Information

NPI Number : 1780297994
Entity Type Code : Organization
Provider Name (Legal Business Name) : RELYMD MEDICAL GROUP KY, LLC
Provider Business Mailing Address
First Line : 510 MEADOWMONT VILLAGE CIR STE 323
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27517-7584
Country : US
Telephone Number : 919-932-0928
Fax Number :
Provider Business Practice Location Address
First Line : 828 LANE ALLEN RD STE 219
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-3659
Country : US
Telephone Number : 919-932-0928
Fax Number :
Authorized Official
Title or Position : CFO/GENERAL COUNSEL
Name : RONALD MICHAEL CREATORE
Credential :
Telephone Number : 919-932-0928
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/26/2020

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