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General NPI Number Information
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NPI Number | 1538446224
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Entity Type | Organization
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Legal Business Name | WESTERN KENTUCKY PAIN MANAGEMENT CENTER
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 3515 FREDERICA ST
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City | OWENSBORO
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State | KY
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Zip | 42301-6902
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Country | US
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Telephone | 270-683-4073
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Fax | 270-683-4075
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Provider Business Mailing Address
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Address Line | 7986 TANNERS GATE LN
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City | FLORENCE
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State | KY
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Zip | 41042-1863
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Country | US
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Telephone | 859-746-2444
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Fax | 859-746-9555
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Authorized Official
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Title or Position | MEMBER
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Name | BRAD HAMBLEN
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Credential |
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Telephone | 859-746-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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