Healthcare Provider Details

I. General information

NPI: 1528156866
Provider Name (Legal Business Name): WEST KENTUCKY RHEUMATOLOGY,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AUGUSTA AVE SUITE A
PADUCAH KY
42003-5584
US

IV. Provider business mailing address

125 AUGUSTA AVE SUITE A
PADUCAH KY
42003-5584
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-0046
  • Fax: 270-534-0048
Mailing address:
  • Phone: 270-534-0046
  • Fax: 270-534-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number26804
License Number StateKY

VIII. Authorized Official

Name: DR. BILLY DEAN BAILEY
Title or Position: PRESIDENT/VICE PRESIDENT
Credential: M.D.
Phone: 270-534-0046