Provider Demographics
NPI:1164478707
Name:KENTUCKY INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:KENTUCKY INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCHEPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-225-1339
Mailing Address - Street 1:125 E MAXWELL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2678
Mailing Address - Country:US
Mailing Address - Phone:859-225-1339
Mailing Address - Fax:859-389-7317
Practice Address - Street 1:125 E MAXWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2678
Practice Address - Country:US
Practice Address - Phone:859-225-1339
Practice Address - Fax:859-389-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65903346Medicaid