Healthcare Provider Details

I. General information

NPI: 1508254087
Provider Name (Legal Business Name): ASAP ADDICTION TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VENTERS LN
PIKEVILLE KY
41501-3016
US

IV. Provider business mailing address

400 VENTERS LN
PIKEVILLE KY
41501-3016
US

V. Phone/Fax

Practice location:
  • Phone: 606-437-0097
  • Fax: 606-657-0205
Mailing address:
  • Phone: 606-437-0097
  • Fax: 606-657-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: EUGENE SISCO
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-437-0097