Provider Demographics
| NPI: | 1326091448 |
|---|---|
| Name: | KENTUCKY MEDICAL SERVICES FOUNDATION, INC |
| Entity Type: | Organization |
| Organization Name: | KENTUCKY MEDICAL SERVICES FOUNDATION, INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | DARRELL |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | GRIFFITH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 859-257-7920 |
| Mailing Address - Street 1: | 2333 ALUMNI PARK PLZ |
| Mailing Address - Street 2: | SUITE 200 |
| Mailing Address - City: | LEXINGTON |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40517-4012 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 859-257-7910 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2333 ALUMNI PARK PLZ |
| Practice Address - Street 2: | SUITE 200 |
| Practice Address - City: | LEXINGTON |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40517-4012 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 859-257-7910 |
| Practice Address - Fax: | 859-257-7899 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-18 |
| Last Update Date: | 2012-08-15 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 5086 | Medicare PIN | ||
| 7292 | Medicare PIN | ||
| 7945 | Medicare PIN | ||
| 0540 | Medicare ID - Type Unspecified | ||
| 0870 | Medicare ID - Type Unspecified | ||
| 6502 | Medicare PIN | ||
| 3760 | Medicare PIN | ||
| 9556 | Medicare PIN | ||
| 6475 | Medicare PIN | ||
| 7762 | Medicare PIN | ||
| 7429 | Medicare PIN | ||
| 5082 | Medicare ID - Type Unspecified | ||
| 0475890001 | Medicare NSC | ||
| 5085 | Medicare ID - Type Unspecified | ||
| 8741 | Medicare PIN | ||
| 6456 | Medicare PIN | ||
| 3769 | Medicare PIN | ||
| 3797 | Medicare PIN | ||
| 6100 | Medicare PIN | ||
| 7766 | Medicare PIN | ||
| 6184 | Medicare ID - Type Unspecified | ||
| 9596 | Medicare PIN |
