Provider Demographics
NPI:1306043401
Name:BARDSTOWN INTERNAL MEDICINE, PSC
Entity Type:Organization
Organization Name:BARDSTOWN INTERNAL MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-348-1990
Mailing Address - Street 1:810 MORTON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2549
Mailing Address - Country:US
Mailing Address - Phone:502-348-1990
Mailing Address - Fax:502-348-1954
Practice Address - Street 1:810 MORTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2549
Practice Address - Country:US
Practice Address - Phone:502-348-1990
Practice Address - Fax:502-348-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF7461OtherRAILROAD MEDICARE
DF7461OtherRAILROAD MEDICARE
DF7461OtherRAILROAD MEDICARE