Provider Demographics
NPI:1881846780
Name:JAMES T DODGE DO LLC
Entity Type:Organization
Organization Name:JAMES T DODGE DO LLC
Other - Org Name:CENTER FOR WOMEN'S HEALTH ARNP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-349-1411
Mailing Address - Street 1:919 CHAMBERS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2574
Mailing Address - Country:US
Mailing Address - Phone:502-349-1411
Mailing Address - Fax:
Practice Address - Street 1:919 CHAMBERS BLVD STE B
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2574
Practice Address - Country:US
Practice Address - Phone:502-349-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES T DODGE DO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2117M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty