Active NPI
Leroy Douglas Couch, DMD
- Dentist
- Corbin, KY
National Provider Identifier
1518015932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7855
- Practice address
- 107 Brentwood PL
Corbin, KY 40701 - Phone
- (606) 528-5600
- Fax
- (606) 528-5604
- NPI assigned
- Jan 8, 2007
- Last updated
- Mar 27, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7855 | KY | Primary |
| General Practice Dentistry | 1223G0001X | 7855 | KY |
Addresses
Primary practice location
107 Brentwood PL
Corbin, KY 40701
Mailing address
107 Brentwood Place
Corbin, KY 40701
Phone (606) 528-5600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60003092 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7855 | KY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206576000000",
"number": "1518015932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 BRENTWOOD PLACE",
"city": "CORBIN",
"state": "KY",
"postal_code": "40701",
"telephone_number": "606-528-5600",
"fax_number": "606-528-5604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 BRENTWOOD PL",
"city": "CORBIN",
"state": "KY",
"postal_code": "40701",
"telephone_number": "606-528-5600",
"fax_number": "606-528-5604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUCH",
"first_name": "LEROY",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2008-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "7855",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "7855",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60003092",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corbin, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.