NPIMap

Organization Active NPI

Marymount Medical Center Physician Services

  • Anesthesiology Physician
  • London, KY
National Provider Identifier
1710951116
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Practice address
1001 Saint Joseph Lane
London, KY 40741-8345
Phone
(606) 330-6000
Fax
(606) 330-7825
NPI assigned
Feb 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

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

Authorized official

Name
Mrs. Kandi R Rea
Title
Credentialing Specialist
Phone
(606) 330-7808

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RE0101X
Pulmonary Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RP1001X
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X 40293 KY
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208G00000X
Hospitalist PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208M00000X
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X
Rural Health Clinic/Center 261QR1300X
Surgical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AS0400X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1001 Saint Joseph Lane
London, KY 40741-8345

Mailing address

740 E Laurel Rd
London, KY 40741-8601
Phone (606) 330-7808

Other identifiers 1

IdentifierTypeStateIssuer
65938177MedicaidKY

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1710951116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 E LAUREL RD",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418601",
            "telephone_number": "606-330-7808",
            "fax_number": "606-330-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SAINT JOSEPH LANE",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418345",
            "telephone_number": "606-330-6000",
            "fax_number": "606-330-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "REA",
        "authorized_official_first_name": "KANDI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "606-330-7808",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": "40293",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65938177",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; 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.