Provider Demographics
NPI:1962400432
Name:CAVE CITY RX CENTER
Entity type:Organization
Organization Name:CAVE CITY RX CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-773-2252
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-0596
Mailing Address - Country:US
Mailing Address - Phone:270-773-2252
Mailing Address - Fax:
Practice Address - Street 1:101 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-0596
Practice Address - Country:US
Practice Address - Phone:270-773-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90013665Medicaid
KY000000070098OtherDME
KY000000070098OtherDME