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LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC NPI 1871626820


NPI Information

NPI: 1871626820
Provider Name: LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC

Other Name: LICKING VALLEY IM PED-CARLISLE

Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 18D0972586

Address:
254 E MAIN ST
CARLISLE, KY
ZIP 40311
Phone: (859) 289-6311
Get Directions

LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC is an internal medicine in Carlisle, KY. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC NPI is 1871626820. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Licking Valley Im Ped-carlisle.

The provider's business location address is:

254 E MAIN ST
CARLISLE, KY
ZIP 40311-156
Phone: (859) 289-6311
Fax: (859) 289-3366

The provider's authorized official is Donna Martin .
The authorized official title is Office Manager and has the following contact phone number (859) 234-9611.

The CLIA number assigned to this NPI record is 18D0972586 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/13/2007 and was last updated on 1/3/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsNo
2363A00000XPhysician AssistantPA783KENTUCKYNo
3363LF0000XNurse PractitionerFamilyNo
4207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
165934341MEDICAIDKENTUCKY
26735MEDICARE PINKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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