Provider Demographics
NPI:1992011050
Name:MD2U KENTUCKY LLC
Entity Type:Organization
Organization Name:MD2U KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-327-9100
Mailing Address - Street 1:9200 SHELBYVILLE RD STE 530
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5144
Mailing Address - Country:US
Mailing Address - Phone:502-327-9100
Mailing Address - Fax:502-742-3767
Practice Address - Street 1:9200 SHELBYVILLE RD STE 530
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5144
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD2U MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP100033337Medicare PIN