Dr Ken Allen Humphrey, MD is a
Emergency Medicine physician based in Lake Wylie, South Carolina. Dr Ken Allen Humphrey is licensed to practice in South Carolina (license number MD-23075) and his current practice location is 15 Cranton Way #112, Suite #112, Lake Wylie, South Carolina. He can be reached at his office (for appointments etc.) via phone at
(803) 831-7916.
NPI number for Dr Ken Allen Humphrey is 1043268352 and his current mailing address is 15 Cranton Way #112, Suite #112, Lake Wylie, South Carolina. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1043268352.
Physician's Profile
| Full Name | Dr Ken Allen Humphrey |
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| Gender | Male |
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| Speciality | Emergency Medicine |
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| Location | 15 Cranton Way #112, Lake Wylie, South Carolina |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1043268352
- Provider Enumeration Date: 05/05/2006
- Last Update Date: 03/04/2010
Medical Identifiers
Medical identifiers for Dr Ken Allen Humphrey such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1043268352 | NPI | - | NPPES |
| 00G409690 | Medicaid | CA | |
| 230752 | Medicaid | SC | |
| 93757018 | Medicaid | NM | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207P00000X | Emergency Medicine | MD2004-0215 (New Mexico) | Secondary |
| 207Q00000X | Family Medicine | G40969 (California) | Secondary |
| 207P00000X | Emergency Medicine | MD-23075 (South Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ken Allen Humphrey is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Ken Allen Humphrey, MD
15 Cranton Way #112, Suite #112,
Lake Wylie, SC 29710
Ph: (803) 831-7916 | Dr Ken Allen Humphrey, MD
15 Cranton Way #112, Suite #112,
Lake Wylie, SC 29710
Ph: (803) 831-7916 |
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