| NPI | 1770741498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEDRICK JOHNSON Vice President 502-352-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: KY 19) | |
| 207RG0100X Internal Medicine Gastroenterology (Licence: KY 19) | |
| 208600000X Surgery (Licence: KY 19) | |
| 363A00000X Physician Assistant (Licence: KY 19) | |
| 363L00000X Nurse Practitioner (Licence: KY 34) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2015-02-06 |