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General NPI Number Information
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NPI Number | 1871150649
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Entity Type | Organization
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Legal Business Name | EAST KY HEALTH SERVICE CENTER
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 566 HIGHWAY 899 # 849
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City | HINDMAN
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State | KY
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Zip | 41822-8955
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Country | US
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Telephone | 606-785-3164
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 849
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City | HINDMAN
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State | KY
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Zip | 41822-0849
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BENNY RAY BAILEY
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Credential | PH D
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Telephone | 606-785-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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