Provider Demographics
NPI:1053504357
Name:GEORGE HAYDEN CAUDILL, P.S.C.
Entity Type:Organization
Organization Name:GEORGE HAYDEN CAUDILL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HAYDEN
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-642-3250
Mailing Address - Street 1:1893 RED FOX RD.
Mailing Address - Street 2:BOX 98
Mailing Address - City:RED FOX
Mailing Address - State:KY
Mailing Address - Zip Code:41847-0098
Mailing Address - Country:US
Mailing Address - Phone:606-642-3250
Mailing Address - Fax:606-642-3740
Practice Address - Street 1:1893 RED FOX RD.
Practice Address - Street 2:BOX 98
Practice Address - City:RED FOX
Practice Address - State:KY
Practice Address - Zip Code:41847-0098
Practice Address - Country:US
Practice Address - Phone:606-642-3250
Practice Address - Fax:606-642-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19066261QP2300X
KY2285P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190663Medicaid
KY64190663Medicaid
KY1190001Medicare PIN