Organization
KENTUCKIANA EAR, NOSE & THROAT PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE SCOTT MD (PRESIDENT)
(812) 283-8770
Entity
Organization
Contact information
Practice address
6420 DUTCHMANS PKWY STE 380, LOUISVILLE, KY 40205-3355
(502) 894-8441
(502) 371-0929
Mailing address
6420 DUTCHMANS PKWY STE 380, LOUISVILLE, KY 40205-3355
(502) 894-8441
(502) 371-0929
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YX0602X
Otolaryngic Allergy Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000057516
ANTHEM KY GP NUMBER
KY
05
—
100001400
—
IN
05
—
65902710
—
KY
Enumeration date
05/26/2006
Last updated
02/16/2018
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