Provider Demographics
NPI:1376849331
Name:KENTUCKY PAIN PHYSICIANS
Entity Type:Organization
Organization Name:KENTUCKY PAIN PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:606-437-9928
Mailing Address - Street 1:180 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1698
Mailing Address - Country:US
Mailing Address - Phone:606-437-9928
Mailing Address - Fax:606-437-9926
Practice Address - Street 1:180 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 113
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1698
Practice Address - Country:US
Practice Address - Phone:606-437-9928
Practice Address - Fax:606-437-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39994261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0996801Medicare PIN