Provider Demographics
NPI:1073795225
Name:CENTRAL KENTUCKY GASTROENTEROLOGY
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:859-266-2999
Mailing Address - Street 1:3225 SUMMIT SQUARE PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-266-7999
Mailing Address - Fax:
Practice Address - Street 1:3225 SUMMIT SQUARE PL
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2659
Practice Address - Country:US
Practice Address - Phone:859-266-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty