=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578719118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMELIA R KISER MD PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2008
-----------------------------------------------------
Last Update Date | 08/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 218 COLUMBIA AVE
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42141-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-651-1221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 430
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42142-0430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-651-1221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMELIA R KISER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 270-651-1221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 33250
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------