Healthcare Provider Details

I. General information

NPI: 1265791057
Provider Name (Legal Business Name): SOMERSET REGIONAL PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 LANGDON ST
SOMERSET KY
42503-2792
US

IV. Provider business mailing address

355 LANGDON ST
SOMERSET KY
42503-2792
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-0683
  • Fax: 606-677-0694
Mailing address:
  • Phone: 606-677-0683
  • Fax: 606-677-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EZEKIEL AKANDE
Title or Position: CEO
Credential:
Phone: 606-677-0683