Provider Demographics
NPI:1114198454
Name:PHYSICIAN EXPRESS CARE BILLING
Entity Type:Organization
Organization Name:PHYSICIAN EXPRESS CARE BILLING
Other - Org Name:PHYSICIAN EXPRESS CARE BILLING ARNP
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KANDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-877-3931
Mailing Address - Street 1:740 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8601
Mailing Address - Country:US
Mailing Address - Phone:606-877-3931
Mailing Address - Fax:606-877-3978
Practice Address - Street 1:148 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:STE 4
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6617
Practice Address - Country:US
Practice Address - Phone:606-878-1181
Practice Address - Fax:606-877-3978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN EXPRESS CARE BILLING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00355Medicare PIN