=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730410275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN M COLBY MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2010
-----------------------------------------------------
Last Update Date | 06/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 KENTON ST SUITE 1A
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42240-1981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-707-8077
-----------------------------------------------------
Fax | 270-707-8037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 86
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42241-0086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-707-8077
-----------------------------------------------------
Fax | 270-707-8037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN M COLBY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 270-707-8077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 22624
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------