| Dolly Albert Boughaba, MD | |
|
405 Southwind Ln, Ludlow, KY 41016-1715 | |
| (513) 470-2777 | |
| Not Available |
| Full Name | Dolly Albert Boughaba |
|---|---|
| Gender | Female |
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 405 Southwind Ln, Ludlow, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376582221 | NPI | - | NPPES |
| 000000804952 | Other | IN | ANTHEM BCBS |
| 200388530 | Medicaid | IN | |
| 64053101 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 01072116A (Indiana) | Primary |
| Entity Name | Appalachian Regional Healthcare Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1871189019 PECOS PAC ID: 0840107835 Enrollment ID: O20031125000520 |
| Entity Name | Appalachian Regional Healthcare Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1861671117 PECOS PAC ID: 0840107835 Enrollment ID: O20080303000476 |
| Entity Name | Arh Mary Breckinridge Health Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1053983908 PECOS PAC ID: 8123293818 Enrollment ID: O20170316001594 |
| Entity Name | Arh Mary Breckinridge Health Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1184156036 PECOS PAC ID: 8123293818 Enrollment ID: O20170728001694 |
| Entity Name | Arh Tug Valley Health Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639949696 PECOS PAC ID: 4183953805 Enrollment ID: O20190905002344 |
| Mailing Address | Practice Location Address |
|---|---|
| Dolly Albert Boughaba, MD 405 Southwind Ln, Ludlow, KY 41016-1715 Ph: (513) 470-2777 | Dolly Albert Boughaba, MD 405 Southwind Ln, Ludlow, KY 41016-1715 Ph: (513) 470-2777 |