NPIMap

Organization Active NPI

Community Care of Kentucky, Inc

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1194103127
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMMUNITY CARE OF KENTUCKY, INC
Practice address
3438 Taylor Blvd
Louisville, KY 40215-2648
Phone
(502) 366-4442
Fax
(502) 366-4446
NPI assigned
May 11, 2015
Last updated
May 11, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY CARE OF KENTUCKY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Authorized official

Name
Mandy Holland
Title
Credentialing Manager
Phone
(256) 504-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3438 Taylor Blvd
Louisville, KY 40215-2648

Mailing address

PO Box 2369
Anniston, AL 36202-2369
Phone (256) 241-3965

Other names 1

  • kentucky05 Other name

National Provider Directory

National Provider Directory
Tax ID family
Community Care of Kentucky Inc2 organizations share this tax ID, including this one
Part of
Community Care of Kentucky Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431302400000",
    "number": "1194103127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2369",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362022369",
            "telephone_number": "256-241-3965",
            "fax_number": "256-241-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3438 TAYLOR BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402152648",
            "telephone_number": "502-366-4442",
            "fax_number": "502-366-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF KENTUCKY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CARE OF KENTUCKY, INC",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-05-11",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "256-504-3326"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "kentucky05",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; 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.