Provider Demographics
NPI:1144633405
Name:KENTUCKYONE HEALTH MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:KENTUCKYONE HEALTH MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-569-7930
Mailing Address - Street 1:200 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 WATER ST
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-8944
Practice Address - Country:US
Practice Address - Phone:606-674-9776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKYONE HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900170261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health