Provider Demographics
NPI:1801078787
Name:HEALTH CARE ACADEMY, INC
Entity type:Organization
Organization Name:HEALTH CARE ACADEMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHEDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-992-4660
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-0304
Mailing Address - Country:US
Mailing Address - Phone:859-992-4660
Mailing Address - Fax:
Practice Address - Street 1:8820 BANKERS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4212
Practice Address - Country:US
Practice Address - Phone:859-992-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200829960Medicaid
KY64030786Medicaid
KY64030786Medicaid
KY9627Medicare PIN
KY0962701Medicare PIN