Provider Demographics
NPI:1568775609
Name:T. ROBERT LOVE M.D.,P.S.C.
Entity Type:Organization
Organization Name:T. ROBERT LOVE M.D.,P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-836-0921
Mailing Address - Street 1:1100 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7055
Mailing Address - Country:US
Mailing Address - Phone:606-836-0921
Mailing Address - Fax:606-836-8175
Practice Address - Street 1:1100 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7055
Practice Address - Country:US
Practice Address - Phone:606-836-0921
Practice Address - Fax:606-836-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25675207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64256753Medicaid
KYC76390Medicare UPIN
KY1462701Medicare PIN