Provider Demographics
NPI:1831411354
Name:KENTUCKY RIVER PHYSICIAN CORPORATION
Entity type:Organization
Organization Name:KENTUCKY RIVER PHYSICIAN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR PHYSICIAN REV CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:1573 MALLORY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2895
Mailing Address - Country:US
Mailing Address - Phone:152-221-1400
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:726 HIGHWAY 15 N
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8601
Practice Address - Country:US
Practice Address - Phone:606-666-2545
Practice Address - Fax:606-666-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700199261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care