Provider Demographics
NPI:1295461663
Name:UNBRIDLED HEALTHCARE SYSTEM LLC
Entity Type:Organization
Organization Name:UNBRIDLED HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-215-3832
Mailing Address - Street 1:PO BOX 2448
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-2448
Mailing Address - Country:US
Mailing Address - Phone:606-770-3014
Mailing Address - Fax:
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1367
Practice Address - Country:US
Practice Address - Phone:606-770-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty