Provider Demographics
NPI:1275590093
Name:CENTRAL KENTUCKY PRIMARY CARE ASSOCIATES PSC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY PRIMARY CARE ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BILLS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:270-932-2424
Mailing Address - Street 1:1911 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-7758
Mailing Address - Country:US
Mailing Address - Phone:270-932-2424
Mailing Address - Fax:270-932-2522
Practice Address - Street 1:1911 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-7758
Practice Address - Country:US
Practice Address - Phone:270-932-2424
Practice Address - Fax:270-932-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78904893Medicaid
9784Medicare ID - Type Unspecified