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General NPI Number Information
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NPI Number | 1528156866
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Entity Type | Organization
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Legal Business Name | WEST KENTUCKY RHEUMATOLOGY,PSC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 125 AUGUSTA AVE SUITE A
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City | PADUCAH
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State | KY
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Zip | 42003-5584
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Country | US
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Telephone | 270-534-0046
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Fax | 270-534-0048
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Provider Business Mailing Address
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Address Line | 125 AUGUSTA AVE SUITE A
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City | PADUCAH
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State | KY
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Zip | 42003-5584
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Country | US
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Telephone | 270-534-0046
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Fax | 270-534-0048
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Authorized Official
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Title or Position | PRESIDENT/VICE PRESIDENT
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Name | DR. BILLY DEAN BAILEY
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Credential | M.D.
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Telephone | 270-534-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 26804
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License Number State | KY
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