Organization Active NPI

The Dermatology Center PSC

  • Dermatology Physician
  • Florence, KY
National Provider Identifier
1104017011
Registry record updated Aug 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
THE DERMATOLOGY CENTER PSC
Practice address
10060 Demia Way
Florence, KY 41042
Phone
(859) 525-6770
Fax
(859) 525-7990
NPI assigned
Aug 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Pamela G Kramer
Title
Office Manager
Phone
(859) 525-6770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

10060 Demia Way
Florence, KY 41042

Mailing address

10060 Demia Way
Florence, KY 41042
Phone (859) 525-6770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615000472 KY Part B Supplier - Clinic/Group Practice 8426032889 Receives reassigned benefits from 6 practitioners
Practice locations: Florence, KY

National Provider Directory

National Provider Directory

Locations

10060 Demia Way
Florence, KY 41042
Phone (859) 525-6770

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1104017011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10060 DEMIA WAY",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "41042",
            "telephone_number": "859-525-6770",
            "fax_number": "859-525-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10060 DEMIA WAY",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "41042",
            "telephone_number": "859-525-6770",
            "fax_number": "859-525-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DERMATOLOGY CENTER PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "859-525-6770",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.