Provider Demographics
NPI:1659316859
Name:HEPATITIS C TREATMENT CENTERS INC
Entity type:Organization
Organization Name:HEPATITIS C TREATMENT CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-727-8268
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-0384
Mailing Address - Country:US
Mailing Address - Phone:502-721-5220
Mailing Address - Fax:502-894-9991
Practice Address - Street 1:1009A N DUPONT SQ
Practice Address - Street 2:STE 203
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-894-9951
Practice Address - Fax:502-894-9991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEPATITIS C TREATMENT CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP068873336C0003X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP06887OtherLICENSE KY
1828144OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY7100122160Medicaid