Provider Demographics
NPI:1538223235
Name:OLDHAM COUNTY PEDIATRICS, PLLC
Entity type:Organization
Organization Name:OLDHAM COUNTY PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA A
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-242-9519
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8568
Mailing Address - Country:US
Mailing Address - Phone:502-225-6277
Mailing Address - Fax:502-225-6270
Practice Address - Street 1:2307 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8568
Practice Address - Country:US
Practice Address - Phone:502-225-6277
Practice Address - Fax:502-225-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65934945Medicaid
KY7100226100Medicaid