Provider Demographics
NPI:1346325081
Name:INTERNAL MEDICINE OF EASTERN KENTUCKY PLLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF EASTERN KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-886-7645
Mailing Address - Street 1:5000 KY RT 321
Mailing Address - Street 2:SUITE 3102
Mailing Address - City:PRESTONBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-886-7645
Mailing Address - Fax:606-886-7427
Practice Address - Street 1:5000 KY RT 321
Practice Address - Street 2:SUITE 3102
Practice Address - City:PRESTONBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-886-7645
Practice Address - Fax:606-886-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty