Healthcare Provider Details

I. General information

NPI: 1720511082
Provider Name (Legal Business Name): KENTUCKY EM-I MEDICAL SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N RACE ST
GLASGOW KY
42141-3454
US

IV. Provider business mailing address

13737 NOEL RD 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax:
Mailing address:
  • Phone: 469-401-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW MULVEY
Title or Position: OFFICER
Credential: MD
Phone: 469-401-2386