Provider Demographics
NPI:1720036429
Name:ANNANDLEE, PLLC
Entity Type:Organization
Organization Name:ANNANDLEE, PLLC
Other - Org Name:BARDSTOWN AMBULATORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-350-1022
Mailing Address - Street 1:118 PATRIOT DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-350-1022
Mailing Address - Fax:502-350-1023
Practice Address - Street 1:118 PATRIOT DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-350-1022
Practice Address - Fax:502-350-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65945263Medicaid
KY78905015Medicaid
KY00013Medicare PIN