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General NPI Number Information
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NPI Number | 1043346562
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Entity Type | Organization
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Legal Business Name | EASTERN KY HEATLHCARE CENTER
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8535 KY RT 122
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City | MINNIE
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State | KY
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Zip | 41651
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Country | US
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Telephone | 606-478-4287
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Fax | 606-478-4288
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | MINNIE
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State | KY
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Zip | 41651-0100
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Country | US
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Telephone | 606-478-4287
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Fax | 606-478-4288
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JACK KENDRICK
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Credential | MD
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Telephone | 606-478-4287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29774
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License Number State | KY
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