Provider Demographics
NPI:1083878946
Name:BRANDON L HOUK MD PSC
Entity Type:Organization
Organization Name:BRANDON L HOUK MD PSC
Other - Org Name:A&B ADULT HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-763-0067
Mailing Address - Street 1:2409 RING RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5933
Mailing Address - Country:US
Mailing Address - Phone:270-763-0067
Mailing Address - Fax:270-763-0087
Practice Address - Street 1:2409 RING RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5933
Practice Address - Country:US
Practice Address - Phone:270-763-0067
Practice Address - Fax:270-763-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100049980Medicaid
KY7100049980Medicaid