Provider Demographics
NPI:1003664574
Name:HOSPITALIST MEDICINE PHYSICIANS OF KENTUCKY - BEREA, PSC
Entity type:Organization
Organization Name:HOSPITALIST MEDICINE PHYSICIANS OF KENTUCKY - BEREA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PAYER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-422-5715
Mailing Address - Street 1:5410 MARYLAND WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5339
Mailing Address - Country:US
Mailing Address - Phone:615-377-5658
Mailing Address - Fax:
Practice Address - Street 1:1210 KY HIGHWAY 36 E UNIT 1
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7665
Practice Address - Country:US
Practice Address - Phone:615-377-5658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty