Provider Demographics
NPI:1457355125
Name:MATTHEW 25 AIDS SERVICES INC
Entity Type:Organization
Organization Name:MATTHEW 25 AIDS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLFORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-826-0200
Mailing Address - Street 1:452 OLD CORYDON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-4645
Mailing Address - Country:US
Mailing Address - Phone:270-826-0200
Mailing Address - Fax:270-826-0212
Practice Address - Street 1:452 OLD CORYDON RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4645
Practice Address - Country:US
Practice Address - Phone:270-826-0200
Practice Address - Fax:270-826-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY740146261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000246990OtherANTHEM KY & IN
IN200408870Medicaid
92-00380OtherUNITED HEALTHCARE
KY23130245OtherPASSPORT HEALTH PLAN
KY78902822Medicaid
KY78902822Medicaid
KY7012Medicare ID - Type UnspecifiedKY MEDICARE
IN200408870Medicaid