Provider Demographics
NPI:1417953209
Name:WESTERN KENTUCKY INSTITUTE OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SU
Entity Type:Organization
Organization Name:WESTERN KENTUCKY INSTITUTE OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VALENTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-885-1140
Mailing Address - Street 1:PO BOX 4025
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-4025
Mailing Address - Country:US
Mailing Address - Phone:270-885-1140
Mailing Address - Fax:270-885-1183
Practice Address - Street 1:1724 KENTON ST
Practice Address - Street 2:SUITE 1 C
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1981
Practice Address - Country:US
Practice Address - Phone:270-885-1140
Practice Address - Fax:270-885-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-26
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty