Provider Demographics
NPI:1437555299
Name:PHYSICIANS HEALTH GROUP OF KENTUCKY, PLLC
Entity Type:Organization
Organization Name:PHYSICIANS HEALTH GROUP OF KENTUCKY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-687-9456
Mailing Address - Street 1:1019 MAJESTIC DR
Mailing Address - Street 2:SUITE 270-D
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1496
Mailing Address - Country:US
Mailing Address - Phone:859-687-9456
Mailing Address - Fax:
Practice Address - Street 1:1019 MAJESTIC DR
Practice Address - Street 2:SUITE 270-D
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1496
Practice Address - Country:US
Practice Address - Phone:859-687-9456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0018703208100000X
225100000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty