Provider Demographics
NPI:1336734912
Name:KENTUCKY CANCERLINK, INC.
Entity Type:Organization
Organization Name:KENTUCKY CANCERLINK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND BILLING REPRESENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-222-7008
Mailing Address - Street 1:2425 REGENCY RD STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2948
Mailing Address - Country:US
Mailing Address - Phone:859-309-1700
Mailing Address - Fax:859-368-8418
Practice Address - Street 1:2425 REGENCY RD STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2948
Practice Address - Country:US
Practice Address - Phone:859-309-1700
Practice Address - Fax:859-368-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care