Provider Demographics
NPI:1346379864
Name:SOUTHERN KY NEPHROLOGY
Entity Type:Organization
Organization Name:SOUTHERN KY NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-843-5114
Mailing Address - Street 1:720 E 2ND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1778
Mailing Address - Country:US
Mailing Address - Phone:270-843-5114
Mailing Address - Fax:
Practice Address - Street 1:720 E 2ND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1778
Practice Address - Country:US
Practice Address - Phone:270-843-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7890181600Medicaid