Healthcare Provider Details

I. General information

NPI: 1386054351
Provider Name (Legal Business Name): WH BOYKIN JR MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 29TH ST SUITE 101
ASHLAND KY
41101-1900
US

IV. Provider business mailing address

336 29TH ST SUITE 101
ASHLAND KY
41101-1900
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-4404
  • Fax: 606-325-6822
Mailing address:
  • Phone: 606-324-4404
  • Fax: 606-325-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number36702
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateKY

VIII. Authorized Official

Name: WILLIAM H BOYKIN JR.
Title or Position: OWNER
Credential: MD
Phone: 606-324-4404