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Organization
KENTUCKY INPATIENT MEDICINE ASSOCIATES, PLLC
Active
Organization
KENTUCKY INPATIENT MEDICINE ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TALBOT GREEN MCCORMICK III MD (PRESIDENT)
(678) 441-8508
Entity
Organization
Contact information
Practice address
1 SAINT JOSEPH DR, SAINT JOSEPH HOSPITAL,, LEXINGTON, KY 40504-3742
(859) 313-2963
(785) 623-5045
Mailing address
5901-C PEACHTREE-DUNWOODY ROAD, SUITE 350, ATLANTA, GA 30328-7159
(678) 441-8556
(678) 441-8656
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
KY
207Q00000X
Family Medicine Physician
—
KY
207R00000X
Internal Medicine Physician
—
KY
208D00000X
General Practice Physician
—
KY
208M00000X
Hospitalist Physician
Primary
—
KY
363A00000X
Physician Assistant
—
KY
363L00000X
Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33J2
BCBS - GROUP
KY
05
—
65901613
—
KY
01
—
78901162
KY MEDICAID - NP GROUP
KY
01
—
CH2140
RR MEDICARE - GROUP
KY
Enumeration date
05/03/2006
Last updated
04/09/2015
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