Provider Demographics
NPI: | 1073194585 |
---|---|
Name: | KMI ACQUISITION LLC |
Entity type: | Organization |
Organization Name: | KMI ACQUISITION LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEVE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FILTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 610-768-3300 |
Mailing Address - Street 1: | 8521 LA GRANGE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40242-3800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-426-6380 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8521 LA GRANGE RD |
Practice Address - Street 2: | |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40242-3800 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-426-6380 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-04-16 |
Last Update Date: | 2021-04-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family | Group - Multi-Specialty |
No | 364SP0811X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Chronically Ill | Group - Multi-Specialty |
No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric | Group - Multi-Specialty |