Basic Information
| Provider Information | |||||||||
| NPI: | 1912973967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THACKER | ||||||||
| FirstName: | DIRK | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1827 | ||||||||
| Address2: | CENTRAL EMERGENCY PHYSICIANS PSC | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592778179 | ||||||||
| FaxNumber: | 8592779320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1740 NICHOLASVILLE RD | ||||||||
| Address2: | CENTRAL BAPTIST HOSPITAL EMERGENCY ROOM | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592606180 | ||||||||
| FaxNumber: | 8592606693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | KY37100 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 64942071 | 05 | KY | MEDICAID |