Healthcare Provider Details

I. General information

NPI: 1811941008
Provider Name (Legal Business Name): STEVEN D. SPADY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-6195
US

IV. Provider business mailing address

509 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-6195
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-8813
  • Fax: 606-599-0983
Mailing address:
  • Phone: 606-598-8813
  • Fax: 606-599-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900134
License Number StateKY

VIII. Authorized Official

Name: DR. STEVEN D SPADY
Title or Position: ADMINISTRATOR
Credential: D.O.
Phone: 606-598-8813