Provider Demographics
NPI:1912909086
Name:ADVANCED TECHNOLOGY OF KENTUCKY INC.
Entity Type:Organization
Organization Name:ADVANCED TECHNOLOGY OF KENTUCKY INC.
Other - Org Name:ADVANCED TECHNOLOGIES INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACKWELDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:859-578-4822
Mailing Address - Street 1:7570 US HWY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2324
Mailing Address - Country:US
Mailing Address - Phone:859-578-4822
Mailing Address - Fax:859-578-4828
Practice Address - Street 1:7570 US HWY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2324
Practice Address - Country:US
Practice Address - Phone:859-578-4822
Practice Address - Fax:859-578-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBL00006890332B00000X
332BX2000X, 335E00000X
OHHMEL11172335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000031913OtherANTHEM
OH0158074Medicaid
KY90990342Medicaid
OH000000031913OtherANTHEM
0945940001Medicare UPIN