Provider Demographics
NPI:1215139829
Name:JOHN P GILLESPIE MD
Entity type:Organization
Organization Name:JOHN P GILLESPIE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-624-2290
Mailing Address - Street 1:789 EASTERN BYP
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2415
Mailing Address - Country:US
Mailing Address - Phone:859-624-2290
Mailing Address - Fax:859-623-5291
Practice Address - Street 1:789 EASTERN BYP
Practice Address - Street 2:SUITE 10
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2415
Practice Address - Country:US
Practice Address - Phone:859-624-2290
Practice Address - Fax:859-623-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY23451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64234511Medicaid
KYC74993Medicare UPIN
KY1385901Medicare ID - Type Unspecified