MEDICARE: ACE CLINIQUE OF MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247100000X	Radiologic Technologist	28914	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	28914	OTHER	KY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1770502791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE CLINIQUE OF MEDICINE

Provider Business Mailing Address
First Line	:	PO BOX 2008
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41702-2008
Country	:	US
Telephone Number	:	606-439-6503
Fax Number	:	606-439-6503

Provider Business Practice Location Address
First Line	:	181 ROY CAMPBELL DR
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41701-0000
Country	:	US
Telephone Number	:	606-439-6503
Fax Number	:	606-439-6503

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. JAMES A CHANEY
Credential	:	M.D.
Telephone Number	:	606-439-6503

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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Directions to “ACE CLINIQUE OF MEDICINE ” Practice Location

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