Provider Demographics
NPI:1356817274
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:AUTHROIZED OFFICIAL, CHAIR, DEPARTM
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-257-7618
Mailing Address - Street 1:UK HEALTHCARE MEDICAL STAFF AFFAIRS
Mailing Address - Street 2:740 S. LIMESTONE K005Q
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-2374
Mailing Address - Fax:
Practice Address - Street 1:845 ANGLIANA AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3146
Practice Address - Country:US
Practice Address - Phone:859-323-9321
Practice Address - Fax:859-257-5232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY MEDICAL SERVICES FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty