Provider Demographics
NPI:1497750194
Name:CENTRAL KENTUCKY EMERGENCY SERVICES P.S.C.
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY EMERGENCY SERVICES P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WETHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-454-4274
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0008
Mailing Address - Country:US
Mailing Address - Phone:800-476-8646
Mailing Address - Fax:919-382-3210
Practice Address - Street 1:727 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1660
Practice Address - Country:US
Practice Address - Phone:502-647-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000060164OtherBCBS 12 DIGIT GROUP #
KY1172544OtherPASSPORT HEALTH GROUP #
KY65929739Medicaid
KY65929739Medicaid