Provider Demographics
NPI:1083938567
Name:WESTERN KENTUCKY NEUROLOGY INC
Entity Type:Organization
Organization Name:WESTERN KENTUCKY NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-419-1592
Mailing Address - Street 1:2108 DARBY DAN DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-7119
Mailing Address - Country:US
Mailing Address - Phone:713-419-1592
Mailing Address - Fax:
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 282 WEST
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:713-419-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY422432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100084760Medicaid
KY42243OtherKENTUCKY BOARD OF MEDICAL LICENSURE: LICENSE NUMBER
1043474844OtherTYPE 1 NPI NUMBER
11877669OtherCAQH PROVIDER ID
KY7100084760Medicaid