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NPI Code Detail

MEDICARE: MY 3 C'S ENTERPRISES, PLLC

MEDICARE: MY 3 C'S ENTERPRISES, PLLC
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
1208D00000XGeneral Practice Physician35818KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000259528OTHERKYBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000259528OTHERKYANTHEM

General Provider Information

NPI Number : 1902027865
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY 3 C'S ENTERPRISES, PLLC
Provider Business Mailing Address
First Line : 1704 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8137
Country : US
Telephone Number : 270-432-4800
Fax Number : 270-432-4804
Provider Business Practice Location Address
First Line : 1704 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8137
Country : US
Telephone Number : 270-432-4800
Fax Number : 270-432-4804
Authorized Official
Title or Position : BILLING MANAGER
Name : MRS. TIFFANY NICHOLE DUNAGAN
Credential : CPC
Telephone Number : 270-432-4800
Provider Enumeration Date : 05/01/2007
Last Update Date : 01/10/2012

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Directions to “MY 3 C'S ENTERPRISES, PLLC ” Practice Location

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