Healthcare Provider Details

I. General information

NPI: 1609292200
Provider Name (Legal Business Name): EASTERN KENTUCKY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 CENTER DR
RICHMOND KY
40475-3838
US

IV. Provider business mailing address

1061 BAY COLONY DR
RICHMOND KY
40475-3845
US

V. Phone/Fax

Practice location:
  • Phone: 859-582-6792
  • Fax:
Mailing address:
  • Phone: 859-582-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number32580
License Number StateKY

VIII. Authorized Official

Name: ASAD JADOON
Title or Position: PRACTICE OWNER
Credential: M.D.
Phone: 859-625-1723