| NPI | 1871275792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BEACHAM Owner 502-515-4903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2025-07-28 |