Provider Demographics
NPI:1952481905
Name:CENTRAL KENTUCKY WOMEN'S HEALTHCARE PSC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY WOMEN'S HEALTHCARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-863-6444
Mailing Address - Street 1:1158 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9330
Mailing Address - Country:US
Mailing Address - Phone:502-863-6444
Mailing Address - Fax:502-863-6334
Practice Address - Street 1:1158 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-863-6444
Practice Address - Fax:502-863-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25340207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7659Medicare PIN