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General NPI Number Information
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NPI Number | 1477665321
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Entity Type | Organization
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Legal Business Name | KENTUCKY PAIN PHYSICIANS
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 286 US HIGHWAY 23 N STE 102
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City | PRESTONSBURG
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State | KY
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Zip | 41653-8732
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Country | US
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Telephone | 606-874-0032
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Fax | 606-874-0064
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Provider Business Mailing Address
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Address Line | 286 US HIGHWAY 23 N STE 102
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City | PRESTONSBURG
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State | KY
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Zip | 41653-8732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIANS ASST
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Name | GERALD PAYNE
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Credential |
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Telephone | 606-874-0032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 39994
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License Number State | KY
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