Provider Demographics
NPI:1710688809
Name:MOREHEAD PEDIATRICS
Entity Type:Organization
Organization Name:MOREHEAD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-498-5243
Mailing Address - Street 1:130 NEWTOWNE SQ
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-2406
Mailing Address - Country:US
Mailing Address - Phone:606-740-0986
Mailing Address - Fax:606-780-9096
Practice Address - Street 1:130 NEWTOWNE SQ
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-2406
Practice Address - Country:US
Practice Address - Phone:606-740-0986
Practice Address - Fax:606-780-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health