| Kentucky Addiction Centers London | |
|
1380 Highway 192 E London KY 40741-3123 | |
| (606) 385-3960 | |
| Not Available |
| Full Name | Kentucky Addiction Centers London |
|---|---|
| Speciality | Family Medicine |
| Location | 1380 Highway 192 E, London, Kentucky |
| Authorized Official Name and Position | Trouper Krueger (CSO-HHR) |
| Authorized Official Contact | 9793245456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky Addiction Centers London 1380 Highway 192 E London KY 40741-3123 Ph: () - | Kentucky Addiction Centers London 1380 Highway 192 E London KY 40741-3123 Ph: (606) 385-3960 |
| NPI Number | 1578159232 |
|---|---|
| Provider Enumeration Date | 12/17/2020 |
| Last Update Date | 10/18/2021 |
| Certification Date | 10/18/2021 |
| Medicare PECOS PAC ID | 5597153437 |
|---|---|
| Medicare Enrollment ID | O20211027000360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578159232 | NPI | - | NPPES |
| Provider Name | Jeffery S Potter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851313266 PECOS PAC ID: 1355247057 Enrollment ID: I20031212000009 |
| Provider Name | Toby R England |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548211410 PECOS PAC ID: 7810919719 Enrollment ID: I20051220000400 |
| Provider Name | Danny W Waddell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477716660 PECOS PAC ID: 3375604242 Enrollment ID: I20081210000577 |
| Provider Name | Tiffany Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487938809 PECOS PAC ID: 0244404242 Enrollment ID: I20111130000511 |
| Provider Name | Craig C Cartia |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1578566766 PECOS PAC ID: 6709868540 Enrollment ID: I20120725000878 |
| Provider Name | Macon S Bradley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851521744 PECOS PAC ID: 5395979256 Enrollment ID: I20131008000808 |
| Provider Name | Sarah E Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013368448 PECOS PAC ID: 9931495116 Enrollment ID: I20160914002408 |
| Provider Name | Sarah Kathleen Dyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699299677 PECOS PAC ID: 9335413822 Enrollment ID: I20170921003310 |
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