Provider Demographics
NPI:1245350370
Name:JOHN AND ANNE HAMILTON, INC.
Entity type:Organization
Organization Name:JOHN AND ANNE HAMILTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PH D
Authorized Official - Phone:502-350-3594
Mailing Address - Street 1:120 W STEPHEN FOSTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1465
Mailing Address - Country:US
Mailing Address - Phone:502-350-3594
Mailing Address - Fax:502-348-3505
Practice Address - Street 1:120 W STEPHEN FOSTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1465
Practice Address - Country:US
Practice Address - Phone:502-350-3594
Practice Address - Fax:502-348-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936650Medicaid
KY65936650Medicaid
KY7004Medicare ID - Type Unspecified