Provider Demographics
NPI:1811088024
Name:M. CARTER ENTERPRISES PLLC
Entity type:Organization
Organization Name:M. CARTER ENTERPRISES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-271-1092
Mailing Address - Street 1:1104 ALDRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6286
Mailing Address - Country:US
Mailing Address - Phone:859-699-6750
Mailing Address - Fax:888-521-2925
Practice Address - Street 1:3217 SUMMIT SQUARE PL STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2642
Practice Address - Country:US
Practice Address - Phone:859-271-1092
Practice Address - Fax:888-521-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7985Medicare ID - Type UnspecifiedGROUP NUMBER