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General NPI Number Information
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NPI Number | 1225544091
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Entity Type | Organization
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Legal Business Name | PELFREY MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 610 FM STAFFORD AVE
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1230
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Country | US
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Telephone | 606-789-5577
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Fax | 606-789-8612
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Provider Business Mailing Address
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Address Line | 610 FM STAFFORD AVE
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1230
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Country | US
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Telephone | 606-789-5577
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Fax | 606-789-8612
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUSAN M LITTON
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Credential |
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Telephone | 606-789-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 100621
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License Number State | KY
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