Provider Demographics
NPI:1922201920
Name:RUTH V HUSSEY DO LLC
Entity Type:Organization
Organization Name:RUTH V HUSSEY DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:859-331-1233
Mailing Address - Street 1:73 CAVALIER BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5179
Mailing Address - Country:US
Mailing Address - Phone:859-331-1233
Mailing Address - Fax:859-376-1026
Practice Address - Street 1:73 CAVALIER BLVD STE 118
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5179
Practice Address - Country:US
Practice Address - Phone:859-331-1233
Practice Address - Fax:859-376-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYK02381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7834OtherMEDICARE GROUP ID LEGACY
KYG11369Medicare UPIN
OH9359411Medicare PIN