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General NPI Number Information
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NPI Number | 1902123870
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Entity Type | Organization
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Legal Business Name | ADVANCED PAIN AND WEIGHT LOSS SOLUTIONS PSC
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 66 ISAIAH LANE STE 2
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City | HUSTONVILLE
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State | KY
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Zip | 40437-0259
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Country | US
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Telephone | 606-346-2795
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 259 66 ISAIAH DRIVE STE 2
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City | HUSTONVILLE
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State | KY
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Zip | 40437-0259
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Country | US
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Telephone | 859-539-1339
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Fax |
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Authorized Official
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Title or Position | CHIEF OFFICE OF OPERATIONS
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Name | JENNIFER R. PELFREY
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Credential | BBA, AS, CMA (AAMA)
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Telephone | 859-539-1339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5466P
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License Number State | KY
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