Provider Demographics
NPI:1013670173
Name:KENTUCKY JOINT SPECIALISTS LLC
Entity Type:Organization
Organization Name:KENTUCKY JOINT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-771-5432
Mailing Address - Street 1:4010 DUPONT CIR STE 310
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4834
Mailing Address - Country:US
Mailing Address - Phone:502-771-5432
Mailing Address - Fax:502-771-5430
Practice Address - Street 1:4010 DUPONT CIR STE 310
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4834
Practice Address - Country:US
Practice Address - Phone:502-771-5432
Practice Address - Fax:502-771-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty