Provider Demographics
NPI:1255437240
Name:JERIUS, HILDE (MD)
Entity type:Individual
Prefix:
First Name:HILDE
Middle Name:
Last Name:JERIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 S 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-3751
Practice Address - Fax:717-270-3754
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39560208600000X, 2086S0129X
PAMD4429062086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255437240Medicaid
KY39560OtherLICENSE
KY64100571Medicaid
000000371200OtherBCBS PROVIDER NUMBER
KYK157742Medicare PIN
KY0745833Medicare PIN
KYK157741Medicare PIN
KYP00281034Medicare PIN
KYK157740Medicare PIN
0935326Medicare PIN
0691687Medicare PIN
KYK157743Medicare PIN