Provider Demographics
NPI:1609064021
Name:RICHARD H. STOUT, MD PSC
Entity Type:Organization
Organization Name:RICHARD H. STOUT, MD PSC
Other - Org Name:ALLERGY AND ASTHMA CLINIC OF W KY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-753-7451
Mailing Address - Street 1:2957 US HWY 641 NORTH
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-7840
Mailing Address - Country:US
Mailing Address - Phone:270-753-7451
Mailing Address - Fax:270-759-1215
Practice Address - Street 1:2957 US HWY 641 NORTH
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-7840
Practice Address - Country:US
Practice Address - Phone:270-753-7451
Practice Address - Fax:270-759-1215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD H STOUT PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13975173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64139751Medicaid
KY64139751Medicaid