Organization
KENTUCKY LAKE UROLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEIGH M HORTON (ASST OFFICE MANAGER)
(731) 642-8884
Entity
Organization
Contact information
Practice address
1002 CORNERSTONE DR, STE A, PARIS, TN 38242
(731) 642-8884
(731) 642-8865
Mailing address
1002 CORNERSTONE DR, STE A, PARIS, TN 38242
(731) 642-8884
(731) 642-8865
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3701995
—
TN
01
—
CM3751
RAILROAD MEDICARE
TN
Enumeration date
04/26/2006
Last updated
01/22/2013
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