Organization
COMMONWEALTH SPECIALISTS OF KENTUCKY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM T. JOHNSON (VP)
(804) 237-7760
Entity
Organization
Contact information
Practice address
299 KINGS DAUGHTERS DR, FRANKFORT, KY 40601-6514
(502) 226-7530
(502) 226-7936
Mailing address
299 KINGS DAUGHTERS DR, SUITE 108, FRANKFORT, KY 40601-6514
(502) 226-7930
(502) 226-7936
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
609106
ANTHEM
KY
05
—
64136732
—
KY
01
—
P00724142
RR MEDICARE
—
Enumeration date
05/15/2008
Last updated
09/30/2009
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