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Kevin J Willis

Family Medicine

Allopathic & Osteopathic Physicians

2201 Lexington Ave, Ashland, KY 41101-2843

PECOS Enrollment

This provider is enrolled in PECOS as KEVIN WILLIS.

Based on the most recent information from CMS, provider Kevin J Willis is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1700919776
Provider Type
Individual
Full Name
Willis, Kevin J
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
3/13/2007
Last Updated
4/7/2017

Contact Information

Practice Location

2201 Lexington Ave, Ashland, KY 41101-2843

(606) 408-4000

(606) 408-7426

Mailing Location

P.O. Box 2379, Ashland, KY 41105-2379

(606) 408-6200

(606) 408-6612

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 25530 Kentucky
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License 35.053911 Ohio
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License 25530 Kentucky

Provider Identifiers

ID	Description	Issuer
ID 0628922	Description Medicaid	Issuer Unlisted Ohio
ID 64255300	Description Medicaid	Issuer Unlisted Kentucky
ID 000000161894	Description Other	Issuer ANTHEM Kentucky
ID 3810010701	Description Medicaid	Issuer Unlisted West Virginia

Kevin J Willis

PECOS Enrollment

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