=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356321723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL MEDICAL STAFFING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 86 HILLTOP LN
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40484-8414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-365-7402
-----------------------------------------------------
Fax | 606-365-9282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 87
-----------------------------------------------------
City | MC KINNEY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40448-0087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-365-7402
-----------------------------------------------------
Fax | 606-365-9282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MR. ROBERT W TODD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-365-7402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------