Provider Demographics
NPI:1518915891
Name:PYMA MEDICAL, PLLC
Entity Type:Organization
Organization Name:PYMA MEDICAL, PLLC
Other - Org Name:PHYSICIANS EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-878-1181
Mailing Address - Street 1:148 LONDON MOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6601
Mailing Address - Country:US
Mailing Address - Phone:606-878-1181
Mailing Address - Fax:606-878-1267
Practice Address - Street 1:148 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-878-1181
Practice Address - Fax:606-878-1267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PYMA MEDICAL,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-05
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78905239Medicaid
KY65944910Medicaid
KY78905239Medicaid