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NPI Code Detail

MEDICARE: KENTUCKY EASTER SEAL SOCIETY INC

MEDICARE: KENTUCKY EASTER SEAL SOCIETY INC
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
1261Q00000XClinic/Center100100KY
2333600000XPharmacyP05154KY
3283X00000XRehabilitation Hospital100100KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31062621OTHERPASSPORT
4253OTHERKYFIRST STEPS
5000000054501OTHERANTHEM

General Provider Information

NPI Number : 1881799807
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENTUCKY EASTER SEAL SOCIETY INC
Provider Business Mailing Address
First Line : 2050 VERSAILLES RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1405
Country : US
Telephone Number : 859-254-5701
Fax Number : 859-233-1615
Provider Business Practice Location Address
First Line : 2050 VERSAILLES RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1405
Country : US
Telephone Number : 859-254-5701
Fax Number : 859-233-1615
Authorized Official
Title or Position : VICE PRESIDENT/CFO
Name : MARTY A. LAUTNER
Credential :
Telephone Number : 859-254-5701
Provider Enumeration Date : 09/14/2006
Last Update Date : 06/08/2012

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Directions to “KENTUCKY EASTER SEAL SOCIETY INC ” Practice Location

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