Provider Demographics
NPI:1922277169
Name:CARENA PHYSICIANS KENTUCKY, INC.
Entity Type:Organization
Organization Name:CARENA PHYSICIANS KENTUCKY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-614-6229
Mailing Address - Street 1:12700 SHELBYVILLE RD
Mailing Address - Street 2:THE DANVILLE BUILDING
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1576
Mailing Address - Country:US
Mailing Address - Phone:502-614-6229
Mailing Address - Fax:
Practice Address - Street 1:12700 SHELBYVILLE RD
Practice Address - Street 2:THE DANVILLE BUILDING
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1576
Practice Address - Country:US
Practice Address - Phone:502-614-6229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARENA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA58200Medicare UPIN