Healthcare Provider Details

I. General information

NPI: 1811437726
Provider Name (Legal Business Name): OPTIMA HEALTH, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 CAMPBELLSVILLE BYP SUITE 5
CAMPBELLSVILLE KY
42718-8843
US

IV. Provider business mailing address

138 CAMPBELLSVILLE BYP SUITE 5
CAMPBELLSVILLE KY
42718-8843
US

V. Phone/Fax

Practice location:
  • Phone: 270-283-4638
  • Fax: 270-283-4639
Mailing address:
  • Phone: 270-283-4638
  • Fax: 270-283-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number03286
License Number StateKY

VIII. Authorized Official

Name: CAROLYN S HARRIS
Title or Position: PRESIDENT
Credential: D.O
Phone: 270-283-4638