Healthcare Provider Details

I. General information

NPI: 1962475301
Provider Name (Legal Business Name): KENTUCKY PAIN PHYSICIANS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 NORTH MAYO TRAIL
PIKEVILLE KY
41501-0000
US

IV. Provider business mailing address

7160 NORTH MAYO TRAIL
PIKEVILLE KY
41501-0000
US

V. Phone/Fax

Practice location:
  • Phone: 606-478-9928
  • Fax: 606-478-7001
Mailing address:
  • Phone: 606-478-9928
  • Fax: 606-478-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT E WINDSOR
Title or Position: OWNER OF TIN/MD
Credential: MD
Phone: 859-252-6500