Provider Demographics
NPI:1043339708
Name:ULRICH MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:ULRICH MEDICAL CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-843-2339
Mailing Address - Street 1:1655 EAST HWY 3094
Mailing Address - Street 2:PO BOX 328
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729
Mailing Address - Country:US
Mailing Address - Phone:606-843-2339
Mailing Address - Fax:606-843-6815
Practice Address - Street 1:1655 E HIGHWAY 3094
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729-6216
Practice Address - Country:US
Practice Address - Phone:606-843-2339
Practice Address - Fax:606-843-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC92143OtherCUMBERLAND HEALTHCARE, IN
KY080138185OtherRAILROAD MEDICARE
KY000000077248OtherBLUE CROSS BLUE SHIELD
KY64196298Medicaid
KY100495OtherFEDERAL BLACK LUNG PROGRA
KY100495OtherFEDERAL BLACK LUNG PROGRA
KY=========OtherHUMANA
KY=========OtherUNITED HEALTHCARE
KYC64825Medicare UPIN