Provider Demographics
NPI:1346281714
Name:PRIMARY HEALTH ASSOCIATES, PSC
Entity Type:Organization
Organization Name:PRIMARY HEALTH ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:859-987-8432
Mailing Address - Street 1:5 LINVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2165
Mailing Address - Country:US
Mailing Address - Phone:859-987-8432
Mailing Address - Fax:859-987-8433
Practice Address - Street 1:5 LINVILLE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2165
Practice Address - Country:US
Practice Address - Phone:859-987-8432
Practice Address - Fax:859-987-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700163261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH04994Medicare UPIN
KY0990701Medicare PIN