Licking Valley Internal Medicine & Pediatrics PSC
Organization Active NPI Internal Medicine Physician · Cynthiana, KY
NPI 1225136153 · NPPES record last updated Apr 7, 2010
Key facts
- NPI
- 1225136153
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC
- Practice address
- 1210 Ky Highway 36 E
Suite 2a
Cynthiana, KY 41031-7490 - Phone
- (859) 234-9611
- Fax
- (859) 235-0878
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. William Frank McKemie Jr., MD
- Title
- President
- Phone
- (859) 234-9611
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Practitioners 4
-
Stephen A Besson, MD
-
Sarah Lindsey Florence, APRN
-
Misti Dixon McNees, APRN
-
Sarah McDowell, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040317000532 | KY | Part B Supplier - Clinic/Group Practice | 3678463379 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment Practice locations: Cynthiana, KY; Paris, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Pediatrics Physician |
208000000X | |||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
1210 Ky Highway 36 E
Suite 2a
Cynthiana, KY 41031-7490
Mailing address
1210 Ky Highway 36 E
Suite 2a
Cynthiana, KY 41031-7490
Phone (859) 234-9611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65934341 | Medicaid | KY |
Other providers in Cynthiana, KY
- Trevor Cole Kohari
- Ky Chiropractic Cynthiana PLLC
- Jayda Lail
- Dwight E Lewis Jr.
- Licking Valley Dental Associates PSC
- Faith Louthan
- James Michael Luckett
- James B Lunsford
- Christopher Maechler
- Toni Rae Dennis Maners
All providers in Cynthiana, KY · Internal Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.