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General NPI Number Information
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NPI Number | 1417953209
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Entity Type | Organization
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Legal Business Name | WESTERN KENTUCKY INSTITUTE OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SU
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Dates
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Enumeration Date | 06/26/2005
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 1724 KENTON ST SUITE 1 C
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1981
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Country | US
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Telephone | 270-885-1140
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Fax | 270-885-1183
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Provider Business Mailing Address
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Address Line | PO BOX 4025
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City | HOPKINSVILLE
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State | KY
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Zip | 42241-4025
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Country | US
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Telephone | 270-885-1140
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Fax | 270-885-1183
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GEORGE R VALENTINI
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Credential | M.D.
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Telephone | 270-885-1140
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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 | 27209
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License Number State | KY
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