Healthcare Provider Details

I. General information

NPI: 1548597016
Provider Name (Legal Business Name): NORTHERN KENTUCKY CENTER FOR PAIN RELIEF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 US HIGHWAY 42
FLORENCE KY
41042-6936
US

IV. Provider business mailing address

8780 US HWY 42 SUITE A
FLORENCE KY
41042
US

V. Phone/Fax

Practice location:
  • Phone: 859-292-0123
  • Fax: 859-292-0131
Mailing address:
  • Phone: 859-292-0123
  • Fax: 859-292-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI SEBASTIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-292-0123