Provider Demographics
NPI:1073792669
Name:BRUCE L KINNEY
Entity Type:Organization
Organization Name:BRUCE L KINNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-478-4287
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0949
Mailing Address - Country:US
Mailing Address - Phone:606-478-4287
Mailing Address - Fax:
Practice Address - Street 1:5000 KY ROUTE 321 STE 2127
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-478-4287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64097256Medicaid
KYDE8139OtherRAILROAD MEDICARE
KY000000384921OtherANTHEM BLUE CROSS
KY9957Medicare PIN