Provider Demographics
NPI:1568834786
Name:DESCHNER MEDICAL SERVICES LLC DEBOSS NEUROLOGY & PAIN CLINIC
Entity Type:Organization
Organization Name:DESCHNER MEDICAL SERVICES LLC DEBOSS NEUROLOGY & PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-979-8856
Mailing Address - Street 1:360 AMSDEN AVE
Mailing Address - Street 2:SPECIALTY SUITE
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1851
Mailing Address - Country:US
Mailing Address - Phone:804-432-8190
Mailing Address - Fax:
Practice Address - Street 1:360 AMSDEN AVE
Practice Address - Street 2:SPECIALTY SUITE
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1851
Practice Address - Country:US
Practice Address - Phone:804-432-8190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP741261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain