Provider Demographics
NPI:1598820037
Name:CENTRAL KENTUCKY EAR, NOSE & THROAT, P.S.C.
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY EAR, NOSE & THROAT, P.S.C.
Other - Org Name:KENTUCKY EAR, NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:859-278-1114
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-278-1114
Mailing Address - Fax:859-278-3774
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-278-1114
Practice Address - Fax:859-278-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI8554OtherRAILROAD MEDICARE ID
CI8554OtherRAILROAD MEDICARE ID