=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073792669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE L KINNEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2007
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 KY ROUTE 321 STE 2127
-----------------------------------------------------
City | PRESTONSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41653-9113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-478-4287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 949
-----------------------------------------------------
City | PAINTSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41240-0949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-478-4287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING COORDINATOR
-----------------------------------------------------
Name | LINDA WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-478-4287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------