Provider Demographics
NPI:1043674989
Name:UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STUDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-202-3318
Mailing Address - Street 1:873 DENZIL AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4026
Mailing Address - Country:US
Mailing Address - Phone:270-202-3318
Mailing Address - Fax:
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:BAYLOR COLLEGE OF MEDICINE, PATHOLOGY, MC 315
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:270-202-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital