Provider Demographics
NPI:1356641757
Name:GOLDENROD HEALTH CORP
Entity type:Organization
Organization Name:GOLDENROD HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBY
Authorized Official - Middle Name:G
Authorized Official - Last Name:THECKEDATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-539-6487
Mailing Address - Street 1:1555 E NEW CIRCLE RD
Mailing Address - Street 2:STE 142-214
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1043
Mailing Address - Country:US
Mailing Address - Phone:859-539-6487
Mailing Address - Fax:
Practice Address - Street 1:1555 E NEW CIRCLE RD
Practice Address - Street 2:STE 142-214
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1043
Practice Address - Country:US
Practice Address - Phone:859-539-6487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38387207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty