| NPI | 1194818138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK G BLACKWELL CFO 606-886-7548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 100124) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner, Family | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist (Licence: KY 100124) | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 282N00000X General Acute Care Hospital (Licence: KY 100124) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2019-06-13 |