Provider Demographics
NPI:1194771592
Name:KENTUCKIANA EAR, NOSE & THROAT PSC
Entity type:Organization
Organization Name:KENTUCKIANA EAR, NOSE & THROAT PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-283-8770
Mailing Address - Street 1:6420 DUTCHMANS PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3355
Mailing Address - Country:US
Mailing Address - Phone:502-894-8441
Mailing Address - Fax:502-371-0929
Practice Address - Street 1:6420 DUTCHMANS PKWY STE 380
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3355
Practice Address - Country:US
Practice Address - Phone:502-894-8441
Practice Address - Fax:502-371-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100001400Medicaid
KY65902710Medicaid
KY000000057516OtherANTHEM KY GP NUMBER
KY2760Medicare ID - Type UnspecifiedKY MEDICARE GROUP NUMBER
KY65902710Medicaid