Provider Demographics
NPI:1114953700
Name:NVMS OF KENTUCKY LLC
Entity Type:Organization
Organization Name:NVMS OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-826-1500
Mailing Address - Street 1:100 BLUEGRASS COMMONS BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2737
Mailing Address - Country:US
Mailing Address - Phone:615-826-1500
Mailing Address - Fax:615-826-2321
Practice Address - Street 1:100 BLUEGRASS COMMONS BLVD
Practice Address - Street 2:STE 150
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2737
Practice Address - Country:US
Practice Address - Phone:615-826-1500
Practice Address - Fax:615-826-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9962Medicare ID - Type Unspecified