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General NPI Number Information
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NPI Number | 1114509759
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Entity Type | Organization
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Legal Business Name | RECONNECT OF PIKEVILLE PSC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 59 THACKER RD
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City | PIKEVILLE
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State | KY
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Zip | 41501-3030
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Country | US
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Telephone | 606-637-2256
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Fax | 606-637-2255
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Provider Business Mailing Address
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Address Line | PO BOX 2802
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City | PIKEVILLE
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State | KY
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Zip | 41502-2802
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Country | US
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Telephone | 606-637-2256
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Fax | 606-637-2255
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BILL WEBB
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Credential | DO
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Telephone | 606-637-2256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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