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General NPI Number Information
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NPI Number | 1902342751
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Entity Type | Organization
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Legal Business Name | KENTUCKY PAIN MANAGEMENT PSC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1939 GOLDSMITH LN STE 117
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City | LOUISVILLE
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State | KY
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Zip | 40218-3176
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Country | US
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Telephone | 502-447-2222
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Fax | 502-448-2215
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Provider Business Mailing Address
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Address Line | 1939 GOLDSMITH LN STE 117
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City | LOUISVILLE
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State | KY
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Zip | 40218-3176
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Country | US
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Telephone | 502-447-2222
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Fax | 502-448-2215
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT W BYRD
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Credential | M.D.
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Telephone | 502-447-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 34304
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License Number State | KY
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