Provider Demographics
NPI:1417001629
Name:AFTER HOUR CARE OF KENTUCKIANA, INC.
Entity Type:Organization
Organization Name:AFTER HOUR CARE OF KENTUCKIANA, INC.
Other - Org Name:EXTRA HOUR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-297-8900
Mailing Address - Street 1:10216 TAYLORSVILLE RD
Mailing Address - Street 2:SUITE 500B
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3616
Mailing Address - Country:US
Mailing Address - Phone:502-297-8900
Mailing Address - Fax:502-240-5654
Practice Address - Street 1:10216 TAYLORSVILLE RD
Practice Address - Street 2:SUITE 500B
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-3616
Practice Address - Country:US
Practice Address - Phone:502-297-8900
Practice Address - Fax:502-240-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0486610261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50009143OtherPASSPORT- CENTRAL STATION
KY65944738Medicaid
KY50008530OtherPASSPORT-JTOWN
KY50009143OtherPASSPORT- CENTRAL STATION