Provider Demographics
NPI:1891797940
Name:SPEACH, ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:SPEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 303
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7915
Mailing Address - Country:US
Mailing Address - Phone:270-444-4222
Mailing Address - Fax:270-444-4223
Practice Address - Street 1:225 MEDICAL CENTER DR STE 303
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7915
Practice Address - Country:US
Practice Address - Phone:270-444-4222
Practice Address - Fax:270-444-4223
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-09-05
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-07-26
Provider Licenses
StateLicense IDTaxonomies
KY26776207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1417499880OtherGROUP NPI
KY611203959OtherTRICARE
KY611203959OtherUNITED HEALTHCARE
KYCM4495OtherPALMETTO GBA-R/R MEDICARE
KY0004267001OtherAETNA U.S. HEALTHCARE
KY000000069025OtherANTHEM BCBS
KY1432663OtherUMWA - FUNDS
KY64267768Medicaid
KY611203959OtherUNITED HEALTHCARE
KYC81922Medicare UPIN