Provider Demographics
NPI:1982639639
Name:GARY W. KEARL PSC
Entity Type:Organization
Organization Name:GARY W. KEARL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-277-9436
Mailing Address - Street 1:870 CORPORATE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5416
Mailing Address - Country:US
Mailing Address - Phone:859-277-9436
Mailing Address - Fax:859-277-1765
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-275-3500
Practice Address - Fax:859-260-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25602174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC66068Medicare UPIN