Southgate Medical of Ky, Inc

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

Legal business name

SOUTHGATE MEDICAL OF KY, INC

Practice address

425 Garrard St
Covington, KY 41011-2562

Phone

(859) 292-8880

Fax

(859) 292-8923

NPI assigned

Feb 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ralph L Stacey II

Title

Owner Administrator

Phone

(859) 292-8880

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1134269384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 GARRARD ST",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410112562",
            "telephone_number": "859-292-8880",
            "fax_number": "859-292-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 GARRARD ST",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410112562",
            "telephone_number": "859-292-8880",
            "fax_number": "859-292-8923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE MEDICAL OF KY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACEY",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "859-292-8880",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9047059200",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Parenteral & Enteral Nutrition Supplies (DME) in Covington, KY
• Providers in Covington, KY by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.