Provider Demographics
NPI:1164829784
Name:KENTUCKY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:KENTUCKY CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATOLOGY PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNARD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:859-323-0101
Mailing Address - Street 1:320 LINDENHURST DR
Mailing Address - Street 2:APT 13107
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1346
Mailing Address - Country:US
Mailing Address - Phone:618-841-6282
Mailing Address - Fax:
Practice Address - Street 1:800 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC337282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren