Healthcare Provider Details

I. General information

NPI: 1730129586
Provider Name (Legal Business Name): DANVILLE PEDIATRICS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S 4TH ST
DANVILLE KY
40422-2004
US

IV. Provider business mailing address

303 S 4TH ST
DANVILLE KY
40422-2004
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-1080
  • Fax: 859-236-1862
Mailing address:
  • Phone: 859-236-1080
  • Fax: 859-236-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. LARRY SCOTT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-236-1080