Provider Demographics
NPI:1295208403
Name:SME KENTUCKY PSC
Entity Type:Organization
Organization Name:SME KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUBUSOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-977-5507
Mailing Address - Street 1:4321 COLLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1851 NW 38TH ST APT 201
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4634
Practice Address - Country:US
Practice Address - Phone:678-977-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty