Provider Demographics
NPI:1760017180
Name:INTEGRATIVE HEALTH CENTERS OF KENTUCKY LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH CENTERS OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-521-9097
Mailing Address - Street 1:1105 16TH AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2327
Mailing Address - Country:US
Mailing Address - Phone:615-521-9097
Mailing Address - Fax:
Practice Address - Street 1:1894 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2206
Practice Address - Country:US
Practice Address - Phone:731-352-0603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty