Provider Demographics
NPI:1629185947
Name:SELECT OB GYN PSC
Entity Type:Organization
Organization Name:SELECT OB GYN PSC
Other - Org Name:LEA & HENSLEY PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-525-1846
Mailing Address - Street 1:6907 BURLINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1618
Mailing Address - Country:US
Mailing Address - Phone:859-525-1846
Mailing Address - Fax:859-647-3355
Practice Address - Street 1:6907 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1618
Practice Address - Country:US
Practice Address - Phone:859-525-1846
Practice Address - Fax:859-647-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65914194Medicaid
KY65914194Medicaid
KS34260Medicare ID - Type UnspecifiedMEDICARE GRP #(OTHER LOC