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General NPI Number Information
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NPI Number | 1679763049
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Entity Type | Organization
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Legal Business Name | KENTUCKY CENTER FOR THE PREVENTION OF HEART ATTACK STOKE AND DIABETES
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 1214 N RACE ST SUITE B
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City | GLASGOW
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State | KY
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Zip | 42141-3462
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Country | US
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Telephone | 270-670-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 N RACE ST SUITE B
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City | GLASGOW
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State | KY
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Zip | 42141-3462
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Country | US
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Telephone | 270-670-8777
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Fax |
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Authorized Official
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Title or Position | OWNER AND PHYSICIAN
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Name | PHILLIP BALE
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Credential |
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Telephone | 270-670-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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