Healthcare Provider Details

I. General information

NPI: 1912207135
Provider Name (Legal Business Name): WESTERN KENTUCKY PAIN MANAGEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 FREDERICA ST
OWENSBORO KY
42301-6902
US

IV. Provider business mailing address

3515 FREDERICA ST
OWENSBORO KY
42301-6902
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-4073
  • Fax: 270-683-4075
Mailing address:
  • Phone: 270-683-4073
  • Fax: 270-683-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE FRANKS
Title or Position: MANAGER
Credential:
Phone: 859-746-2444