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General NPI Number Information
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NPI Number | 1053647313
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Entity Type | Organization
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Legal Business Name | EASTERN KENTUCKY PAIN MANAGEMENT CENTER LLC
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 1694 NORTHGATE DR
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City | RICHMOND
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State | KY
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Zip | 40475-1066
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Country | US
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Telephone | 859-626-7755
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Fax | 859-626-7766
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Provider Business Mailing Address
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Address Line | 1694 NORTHGATE DR
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City | RICHMOND
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State | KY
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Zip | 40475-1066
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Country | US
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Telephone | 859-626-7755
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Fax | 859-626-7766
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Authorized Official
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Title or Position | MEMBER
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Name | BRAD HAMBLEN
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Credential |
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Telephone | 859-746-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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