MEDICARE: UNBOUND TREATMENT, INC.

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	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1952994055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNBOUND TREATMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 623
Second Line	:
City	:	JAMESTOWN
State	:	KY
Zip	:	42629-0623
Country	:	US
Telephone Number	:	866-286-2686
Fax Number	:	855-929-4545

Provider Business Practice Location Address
First Line	:	601 N SHORE DR STE 102
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3144
Country	:	US
Telephone Number	:	866-286-2686
Fax Number	:	855-929-4545

Authorized Official
Title or Position	:	LAWYER
Name	:	ANNA WHITES
Credential	:
Telephone Number	:	502-352-2373

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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