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General NPI Number Information
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NPI Number | 1295097319
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Entity Type | Organization
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Legal Business Name | KENTUCKY BREAST CARE
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 38 JOE T PETTY DRIVE
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-8553
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Country | US
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Telephone | 606-658-9535
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Fax | 270-866-9716
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Provider Business Mailing Address
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Address Line | 38 JOE T PETTEY DRIVE
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-8553
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Country | US
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Telephone | 606-658-9535
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Fax | 270-866-9716
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANDREA WOODROOF
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Credential | M.D.
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Telephone | 606-658-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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