Provider Demographics
NPI:1346766441
Name:INTEGRATED PAIN MANAGEMENT OF KENTUCKY LLC
Entity Type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT OF KENTUCKY LLC
Other - Org Name:BREAKTHROUGH HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:598-495-7246
Mailing Address - Street 1:8780 US HIGHWAY 42 STE E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-6936
Mailing Address - Country:US
Mailing Address - Phone:859-495-7246
Mailing Address - Fax:598-292-0131
Practice Address - Street 1:8780 US HIGHWAY 42 STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6936
Practice Address - Country:US
Practice Address - Phone:859-495-7246
Practice Address - Fax:598-292-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2838808Medicaid
KY64311541Medicaid