1275869083 NPI number — EASTERN KENTUCKY COMPREHENSIVE CARE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275869083 NPI number — EASTERN KENTUCKY COMPREHENSIVE CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN KENTUCKY COMPREHENSIVE CARE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275869083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-886-1077
Provider Business Mailing Address Fax Number:
606-886-1170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 PROFESSOR CLARKE CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINDMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41822-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-8240
Provider Business Practice Location Address Fax Number:
606-886-8243
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRACE
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
PARKER
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
606-886-1077

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)