Provider Demographics
NPI:1043497167
Name:JAMES T DODGE DO LLC
Entity Type:Organization
Organization Name:JAMES T DODGE DO LLC
Other - Org Name:CENTER FOR WOMENS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-349-1411
Mailing Address - Street 1:919 CHAMBERS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2574
Mailing Address - Country:US
Mailing Address - Phone:502-349-1411
Mailing Address - Fax:502-349-0980
Practice Address - Street 1:919 CHAMBERS BLVD STE B
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2574
Practice Address - Country:US
Practice Address - Phone:502-349-1411
Practice Address - Fax:502-349-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02609207V00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65939969Medicaid
KY7789OtherGROUP
KY7789Medicare PIN
KYH09865Medicare UPIN