Healthcare Provider Details

I. General information

NPI: 1750323366
Provider Name (Legal Business Name): CENTRAL KENTUCKY PAIN PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 WILHITE CT STE 101
LEXINGTON KY
40503-3327
US

IV. Provider business mailing address

2628 WILHITE CT STE 101
LEXINGTON KY
40503-3327
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-0100
  • Fax: 859-277-1115
Mailing address:
  • Phone: 859-276-0100
  • Fax: 859-277-1115

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: HAROLD H. RUTLEDGE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 859-276-0100