Provider Demographics
NPI:1285942649
Name:ERENA & PETERSON, PLLC
Entity type:Organization
Organization Name:ERENA & PETERSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-268-4423
Mailing Address - Street 1:620 PERIMETER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4125
Mailing Address - Country:US
Mailing Address - Phone:859-268-4423
Mailing Address - Fax:859-268-0010
Practice Address - Street 1:620 PERIMETER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4125
Practice Address - Country:US
Practice Address - Phone:859-268-4423
Practice Address - Fax:859-268-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100158900OtherMEDICAID MEDICAL
KY7100150110OtherMEDICAID DENTAL
P100036989OtherMEDICARE PTAN