Healthcare Provider Details

I. General information

NPI: 1376693788
Provider Name (Legal Business Name): MEDICAL SERVICES OF KENTUCKY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 JAMES TRIMBLE BLVD
PAINTSVILLE KY
41240-1055
US

IV. Provider business mailing address

PO BOX 2078
HUNTINGTON WV
25720-2078
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-3511
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VINCENT MORRA
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 800-377-8721