Provider Demographics
NPI:1700943826
Name:CHYRON LLC
Entity Type:Organization
Organization Name:CHYRON LLC
Other - Org Name:THE UNDERWOOD AND LEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-368-2348
Mailing Address - Street 1:1800 BLUEGRASS AVENUE, STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215
Mailing Address - Country:US
Mailing Address - Phone:502-368-2348
Mailing Address - Fax:502-368-2340
Practice Address - Street 1:1800 BLUEGRASS AVENUE, STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215
Practice Address - Country:US
Practice Address - Phone:502-368-2348
Practice Address - Fax:502-368-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61901047Medicaid