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General NPI Number Information
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NPI Number | 1417255514
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASE ASSOCIATES OF SOUTHEASTERN KENTUCKY PSC
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 200 MEDICAL CENTER DR
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City | HAZARD
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State | KY
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Zip | 41701-9466
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Country | US
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Telephone | 606-439-0800
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Fax | 606-439-6773
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Provider Business Mailing Address
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Address Line | PO BOX 1448
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City | HAZARD
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State | KY
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Zip | 41702-1448
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Country | US
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Telephone | 606-439-0800
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Fax | 606-439-6773
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Authorized Official
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Title or Position | OWNER
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Name | DR. BEKOE BERNDT OPOKU-OWUSU
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Credential | M.D.
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Telephone | 606-439-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 40016
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License Number State | KY
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