Healthcare Provider Details

I. General information

NPI: 1225544091
Provider Name (Legal Business Name): PELFREY MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FM STAFFORD AVE
PAINTSVILLE KY
41240-1230
US

IV. Provider business mailing address

610 FM STAFFORD AVE
PAINTSVILLE KY
41240-1230
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-5577
  • Fax: 606-789-8612
Mailing address:
  • Phone: 606-789-5577
  • Fax: 606-789-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number100621
License Number StateKY

VIII. Authorized Official

Name: SUSAN M LITTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-789-5577