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General NPI Number Information
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NPI Number | 1730337247
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Entity Type | Organization
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Legal Business Name | EASTERN KENTUCKY FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 713 BROADWAY ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1465
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Country | US
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Telephone | 606-789-4255
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Fax | 606-886-9908
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Provider Business Mailing Address
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Address Line | P.O. BOX 1810
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City | PRESTONSBURG
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State | KENTUCKY
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Zip | 41653
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Country | UM
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Telephone | 606-886-0224
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Fax | 606-886-9908
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JASON CASTLE
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Credential | M.D.
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Telephone | 606-789-4255
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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 | 42069
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License Number State | KY
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