Provider Demographics
NPI:1366479248
Name:HURT, BUDDY (DO)
Entity Type:Individual
Prefix:
First Name:BUDDY
Middle Name:
Last Name:HURT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:117 CROSSFIELD DR STE B
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1844
Practice Address - Country:US
Practice Address - Phone:859-873-9188
Practice Address - Fax:859-873-0870
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2177207Q00000X
KY02563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64001886Medicaid
OH2662604Medicaid
WV3810005690Medicaid
WV3810005690Medicaid
WV2027511Medicare PIN
OH2662604Medicaid
WVWV1601AMedicare PIN
WVWV1601B674Medicare PIN
WV2034161Medicare PIN
WV4185401Medicare PIN
KY64001886Medicaid
WV3810005690Medicaid
WV2027521Medicare PIN
WV2027501Medicare PIN
WV00326306OtherRR MEDICARE