Healthcare Provider Details

I. General information

NPI: 1326005166
Provider Name (Legal Business Name): PACK MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 GREENUP AVE
ASHLAND KY
41101-7615
US

IV. Provider business mailing address

PO BOX 2203
ASHLAND KY
41105-2203
US

V. Phone/Fax

Practice location:
  • Phone: 606-920-9701
  • Fax: 606-920-9716
Mailing address:
  • Phone: 606-920-9701
  • Fax: 606-920-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. CHARLES FRANKLIN VANOVER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 606-920-9701