Provider Demographics
NPI:1265693758
Name:HENRY M WEST MD PLLC
Entity type:Organization
Organization Name:HENRY M WEST MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-879-3115
Mailing Address - Street 1:290 LEXINGTON ST
Mailing Address - Street 2:P.O.BOX 846
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1240
Mailing Address - Country:US
Mailing Address - Phone:859-879-3115
Mailing Address - Fax:859-879-3818
Practice Address - Street 1:290 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1240
Practice Address - Country:US
Practice Address - Phone:859-879-3115
Practice Address - Fax:859-879-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20583261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000323903OtherANTHEM
KY000000323903OtherANTHEM
KY1828801Medicare PIN