Provider Demographics
NPI:1447769641
Name:KEN HOMOLYA MD LLC
Entity Type:Organization
Organization Name:KEN HOMOLYA MD LLC
Other - Org Name:INTEGRITY PAIN CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOMOLYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-431-5484
Mailing Address - Street 1:103 HAZEL PATH STE 7
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3893
Mailing Address - Country:US
Mailing Address - Phone:615-431-5484
Mailing Address - Fax:615-447-5959
Practice Address - Street 1:5114 OLD HICKORY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2590
Practice Address - Country:US
Practice Address - Phone:615-850-6960
Practice Address - Fax:615-777-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty