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NPI Code Detail

MEDICARE: WEST KENTUCKY DERMATOLOGY, PSC

MEDICARE: WEST KENTUCKY DERMATOLOGY, PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1053536037
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST KENTUCKY DERMATOLOGY, PSC
Provider Business Mailing Address
First Line : 1851 N MAIN ST
Second Line :
City : MADISONVILLE
State : KY
Zip : 42431-9007
Country : US
Telephone Number : 270-821-0066
Fax Number : 270-821-6580
Provider Business Practice Location Address
First Line : 1102 S VIRGINIA ST
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-3579
Country : US
Telephone Number : 270-707-1160
Fax Number : 270-881-9001
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM F SMITH III
Credential : M.D.
Telephone Number : 270-821-0066
Provider Enumeration Date : 04/16/2007
Last Update Date : 10/07/2008

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Directions to “WEST KENTUCKY DERMATOLOGY, PSC ” Practice Location

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