Provider Demographics
NPI:1932384468
Name:HEPATITIS C TREATMENT CENTER INC
Entity Type:Organization
Organization Name:HEPATITIS C TREATMENT CENTER INC
Other - Org Name:HCTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENNET
Authorized Official - Middle Name:DOWNS
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-721-5220
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-0384
Mailing Address - Country:US
Mailing Address - Phone:502-225-5214
Mailing Address - Fax:502-225-5858
Practice Address - Street 1:1009A N DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-894-9951
Practice Address - Fax:502-894-9991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEPATITIS C TREATMENT CENTERS INC.,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO6887333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904039Medicaid
KY5758Medicare UPIN
KYC74439Medicare UPIN