Provider Demographics
NPI:1124393285
Name:KENTUCKIANA PREMIER PST CENTER, LLC
Entity Type:Organization
Organization Name:KENTUCKIANA PREMIER PST CENTER, LLC
Other - Org Name:KPTC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-532-1811
Mailing Address - Street 1:605 N SHORE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3134
Mailing Address - Country:US
Mailing Address - Phone:502-532-1811
Mailing Address - Fax:502-410-0445
Practice Address - Street 1:605 N SHORE DR
Practice Address - Street 2:STE 202
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3134
Practice Address - Country:US
Practice Address - Phone:502-532-1811
Practice Address - Fax:502-410-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty