Provider Demographics
NPI:1386808095
Name:DENNIS G SHOFF MD PSC
Entity type:Organization
Organization Name:DENNIS G SHOFF MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HEALTHCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:SHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-765-6141
Mailing Address - Street 1:1310 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-765-6141
Mailing Address - Fax:270-765-6141
Practice Address - Street 1:1310 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-6141
Practice Address - Fax:270-765-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2435204000Medicaid
160005568OtherRAILROAD MEDICARE
000000062512OtherBCBS
KYC69105Medicare UPIN
KY0096702Medicare PIN