Provider Demographics
NPI:1760667299
Name:HEPATITIS C TREATMENT CENTERS INC
Entity Type:Organization
Organization Name:HEPATITIS C TREATMENT CENTERS INC
Other - Org Name:HCTC INC.,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:502-727-8268
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-0384
Mailing Address - Country:US
Mailing Address - Phone:502-894-9951
Mailing Address - Fax:502-225-5858
Practice Address - Street 1:1009 N DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-721-5220
Practice Address - Fax:502-894-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY21721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64217219Medicaid
KY65904039Medicaid
KY65904039Medicaid
KY64217219Medicaid