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General NPI Number Information
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NPI Number | 1508378738
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Entity Type | Organization
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Legal Business Name | PERFORMANCE MEDICINE LLC
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Dates
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Enumeration Date | 10/27/2017
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 110 W VINE ST
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City | LEXINGTON
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State | KY
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Zip | 40507-1658
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Country | US
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Telephone | 859-208-6781
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Fax | 859-208-6803
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Provider Business Mailing Address
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Address Line | 3050 POST OAK BLVD STE 510
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City | HOUSTON
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State | TX
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Zip | 77056-6512
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Country | US
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Telephone | 866-943-2384
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Fax | 713-885-9572
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Authorized Official
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Title or Position | OWNER
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Name | DR. KANISHA HALL
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Credential | MD
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Telephone | 202-709-9822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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