Provider Demographics
NPI:1922001833
Name:COLORECTAL CARE OF NORTHERN KY, PLLC
Entity Type:Organization
Organization Name:COLORECTAL CARE OF NORTHERN KY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-341-9659
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-0272
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-891-1039
Practice Address - Street 1:2865 CHANCELLOR DR
Practice Address - Street 2:STE 215
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3912
Practice Address - Country:US
Practice Address - Phone:859-341-9659
Practice Address - Fax:859-341-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD6452OtherRAILROAD MEDICARE
OH2948949Medicaid
IN200927190AMedicaid
OHDD6452OtherRAILROAD MEDICARE