Healthcare Provider Details

I. General information

NPI: 1275601049
Provider Name (Legal Business Name): PAIN CARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE SUITE 8 B
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

PO BOX 1109
ASHLAND KY
41105-1109
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-5190
  • Fax: 606-408-6693
Mailing address:
  • Phone: 606-408-5190
  • Fax: 606-408-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEON B. BRIGGS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 606-408-5190