Basic Information
| Provider Information | |||||||||
| NPI: | 1831167071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | METCALFE | ||||||||
| FirstName: | MONTY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407430936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063307818 | ||||||||
| FaxNumber: | 6063307825 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 BOB O LINK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592243194 | ||||||||
| FaxNumber: | 8592193304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 20208 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000053287 | 01 | ANTHEM BLUECRASSBLUESHIEL | OTHER | 1400579 | 01 | KY | FIRST HEALTH | OTHER | 20208 | 01 | KY | STATE LICENSE | OTHER | 830001052 | 01 | KY | RAILROAD MEDICARE | OTHER | 4274328 | 01 | KY | AETNA | OTHER | AM8755273 | 01 | KY | DEA | OTHER | 64202088 | 05 | KY | MEDICAID |