Provider Demographics
NPI:1831207984
Name:CENTRAL KENTUCKY MOBILITY
Entity type:Organization
Organization Name:CENTRAL KENTUCKY MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:895-255-3624
Mailing Address - Street 1:1050 ENTERPRISE DR
Mailing Address - Street 2:STE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40510-1014
Mailing Address - Country:US
Mailing Address - Phone:859-255-3624
Mailing Address - Fax:
Practice Address - Street 1:1050 ENTERPRISE DR
Practice Address - Street 2:STE 125
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40510-1016
Practice Address - Country:US
Practice Address - Phone:859-255-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY247648332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000295533OtherANTHEM FACETS
KY45001658Medicaid
KY90005653Medicaid
KY000000295533OtherANTHEM FACETS