Provider Demographics
NPI:1083887459
Name:HAROLD S. MOBERLY M.D. PSC
Entity Type:Organization
Organization Name:HAROLD S. MOBERLY M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-744-2732
Mailing Address - Street 1:246 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1957
Mailing Address - Country:US
Mailing Address - Phone:859-744-2732
Mailing Address - Fax:
Practice Address - Street 1:246 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1957
Practice Address - Country:US
Practice Address - Phone:859-744-2732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY207Q00000XOtherTAXONOMY
KY65913196Medicaid
KY000000047309OtherANTHEM
KY64120140Medicaid
KYC71772Medicare UPIN
KY000000047309OtherANTHEM