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General NPI Number Information
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NPI Number | 1053646745
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Entity Type | Organization
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Legal Business Name | PRESTONSBURG HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 113 REGENCY PARK
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City | PRESTONSBURG
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State | KY
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Zip | 41653-9127
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Country | US
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Telephone | 606-886-3077
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Fax | 606-886-3078
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Provider Business Mailing Address
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Address Line | 115 WALLEN DR
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City | VAN LEAR
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State | KY
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Zip | 41265-9045
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Country | US
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Telephone | 606-886-3077
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Fax | 606-886-3078
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Authorized Official
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Title or Position | INCORPORATOR
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Name | DR. LAURA JEAN HAZELTINE
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Credential | M.D.
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Telephone | 606-886-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25775
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License Number State | KY
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