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General NPI Number Information
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NPI Number | 1306108618
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Entity Type | Organization
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Legal Business Name | TRI-STATE ADVANCED PAIN MANAGEMENT
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 444 S MAIN ST SUITE 133
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City | MADISONVILLE
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State | KY
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Zip | 42431-2846
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Country | US
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Telephone | 270-825-4732
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Fax | 270-825-4733
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Provider Business Mailing Address
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Address Line | 3332 VILLA PT SUITE 104
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City | OWENSBORO
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State | KY
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Zip | 42303-7818
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Country | US
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Telephone | 270-684-5679
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Fax | 270-684-5753
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUK KI KIM
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Credential | M.D.
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Telephone | 270-684-5679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 17728
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License Number State | KY
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