Provider Demographics
NPI:1003991621
Name:WESTERN KENTUCKY CENTRE FOR PSYCHIATRIC MEDICINE PLLC
Entity Type:Organization
Organization Name:WESTERN KENTUCKY CENTRE FOR PSYCHIATRIC MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUESS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-322-1122
Mailing Address - Street 1:7805 HANSON RD
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-9524
Mailing Address - Country:US
Mailing Address - Phone:270-322-1122
Mailing Address - Fax:270-322-1155
Practice Address - Street 1:7805 HANSON RD
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:KY
Practice Address - Zip Code:42413-9524
Practice Address - Country:US
Practice Address - Phone:270-322-1122
Practice Address - Fax:270-322-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942765Medicaid
KY65942765Medicaid
KYE43899Medicare UPIN