| Matthew 25 Aids Services Inc | |
|
452 Old Corydon Rd Henderson KY 42420-4645 | |
| (270) 826-0200 | |
| (270) 826-0212 |
| Full Name | Matthew 25 Aids Services Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 452 Old Corydon Rd, Henderson, Kentucky |
| Authorized Official Name and Position | Courtney Woolfork (CEO) |
| Authorized Official Contact | 2708260200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew 25 Aids Services Inc 452 Old Corydon Rd Henderson KY 42420-4645 Ph: (270) 826-0200 | Matthew 25 Aids Services Inc 452 Old Corydon Rd Henderson KY 42420-4645 Ph: (270) 826-0200 |
| NPI Number | 1457355125 |
|---|---|
| Provider Enumeration Date | 06/09/2005 |
| Last Update Date | 10/05/2023 |
| Medicare PECOS PAC ID | 3375513641 |
|---|---|
| Medicare Enrollment ID | O20040727000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457355125 | NPI | - | NPPES |
| 000000246990 | Other | KY | ANTHEM KY & IN |
| 200408870 | Medicaid | IN | |
| 92-00380 | Other | UNITED HEALTHCARE | |
| 23130245 | Other | KY | PASSPORT HEALTH PLAN |
| 78902822 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 740146 (Kentucky) | Primary |
| Provider Name | Misty R Hartmire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417206541 PECOS PAC ID: 5890930549 Enrollment ID: I20130328000371 |
| Provider Name | William L Kaelin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922408392 PECOS PAC ID: 9335369016 Enrollment ID: I20140930002817 |
| Provider Name | Danielle N Board |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841965936 PECOS PAC ID: 9830589886 Enrollment ID: I20211206001466 |
| Provider Name | Charlie C Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245996644 PECOS PAC ID: 8820485220 Enrollment ID: I20220504001592 |
| Provider Name | Brittney L Van Laeken |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225703770 PECOS PAC ID: 3274921788 Enrollment ID: I20230216001979 |
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