Provider Demographics
NPI:1942481577
Name:KIMBERLY M. BALDOCK MD PSC
Entity Type:Organization
Organization Name:KIMBERLY M. BALDOCK MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-920-9595
Mailing Address - Street 1:1816 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7643
Mailing Address - Country:US
Mailing Address - Phone:606-920-9595
Mailing Address - Fax:
Practice Address - Street 1:1816 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7643
Practice Address - Country:US
Practice Address - Phone:606-920-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30472174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG6363OtherRAILROAD MEDICARE
KY000000689129OtherANTHEM BCBS
KY64304728Medicaid
KYP40034691Medicare PIN
KY1605001Medicare PIN
KY000000689129OtherANTHEM BCBS