Provider Demographics
NPI:1912081423
Name:ESSENTIAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OXNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-331-0411
Mailing Address - Street 1:809 MORTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2565
Mailing Address - Country:US
Mailing Address - Phone:502-331-0411
Mailing Address - Fax:502-331-0380
Practice Address - Street 1:809 MORTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2565
Practice Address - Country:US
Practice Address - Phone:502-331-0411
Practice Address - Fax:502-331-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
KY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64283120Medicaid
KY6073Medicare PIN
KY64283120Medicaid