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General NPI Number Information
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NPI Number | 1629346945
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Entity Type | Organization
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Legal Business Name | SOUTH KENTUCKY PHYSICIAN SERVICES, INC.
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 202-206 MILBY STREET
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City | GREENSBURG
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State | KY
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Zip | 42743
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Country | US
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Telephone | 270-634-1921
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Fax |
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Provider Business Mailing Address
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Address Line | 1597 BLISS RD
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City | COLUMBIA
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State | KY
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Zip | 42728-8510
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Country | US
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Telephone | 270-634-1921
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. GARY LEDFORD PARTIN
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Credential | MD
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Telephone | 270-634-1921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25262
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License Number State | KY
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