Provider Demographics
NPI:1982177572
Name:PENNYRILE NEPHROLOGY ASSOCIATES, PSC
Entity Type:Organization
Organization Name:PENNYRILE NEPHROLOGY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-821-5726
Mailing Address - Street 1:1020 WATERFALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8079
Mailing Address - Country:US
Mailing Address - Phone:270-821-5726
Mailing Address - Fax:270-326-2090
Practice Address - Street 1:1020 WATERFALL CT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8079
Practice Address - Country:US
Practice Address - Phone:270-399-5434
Practice Address - Fax:270-825-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100284170Medicaid