Organization
CENTRAL KENTUCKY EMERGENCY SERVICES P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDEN M WETHERTON MD (MEDICAL DIRECTOR)
(502) 454-4274
Entity
Organization
Contact information
Practice address
727 HOSPITAL DR, SHELBYVILLE, KY 40065-1660
(502) 647-4347
Mailing address
PO BOX 8, LOUISVILLE, KY 40201-0008
(800) 476-8646
(919) 382-3210
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000060164
BCBS 12 DIGIT GROUP #
KY
01
—
1172544
PASSPORT HEALTH GROUP #
KY
05
—
65929739
—
KY
Enumeration date
06/17/2005
Last updated
07/21/2022
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