Provider Demographics
NPI:1376515528
Name:KENTUCKY PAIN PHYSICIANS, PSC
Entity Type:Organization
Organization Name:KENTUCKY PAIN PHYSICIANS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF TIN/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-252-6500
Mailing Address - Street 1:320 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9418
Mailing Address - Country:US
Mailing Address - Phone:606-487-8383
Mailing Address - Fax:606-487-8122
Practice Address - Street 1:320 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9418
Practice Address - Country:US
Practice Address - Phone:606-487-8383
Practice Address - Fax:606-487-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926552Medicaid
KYCD2933OtherRR MEDICARE
OH2472800Medicaid
WV3810003494Medicaid