Provider Demographics
NPI:1548597016
Name:NORTHERN KENTUCKY CENTER FOR PAIN RELIEF, LLC
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY CENTER FOR PAIN RELIEF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-292-0123
Mailing Address - Street 1:8780 US HWY 42
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-292-0123
Mailing Address - Fax:859-292-0131
Practice Address - Street 1:8780 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6936
Practice Address - Country:US
Practice Address - Phone:859-292-0123
Practice Address - Fax:859-292-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100173410Medicaid
KY01175Medicare PIN
KY7100173410Medicaid
KY01175002Medicare PIN
KY7100095410Medicaid
KY7100116100Medicaid
KY01175002Medicare PIN