1366442105 NPI number — PHYSICAL MEDICINE SERVICES, INC.

Table of content: (NPI 1366442105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366442105 NPI number — PHYSICAL MEDICINE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL MEDICINE SERVICES, INC.
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:
1366442105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 VINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42071-2630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-753-6477
Provider Business Mailing Address Fax Number:
270-753-6478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
732 VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-753-6477
Provider Business Practice Location Address Fax Number:
270-753-6478
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WINKLER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
270-753-6477

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  KY001536 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000059678 . This is a "ANTHEM BCBS/GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8700036000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: C10478 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000049118 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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