Provider Demographics
NPI:1609292200
Name:EASTERN KENTUCKY MEDICAL SERVICES
Entity Type:Organization
Organization Name:EASTERN KENTUCKY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JADOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-625-1723
Mailing Address - Street 1:1061 BAY COLONY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3845
Mailing Address - Country:US
Mailing Address - Phone:859-582-2458
Mailing Address - Fax:
Practice Address - Street 1:1042 CENTER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3838
Practice Address - Country:US
Practice Address - Phone:859-582-6792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32580207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1903101Medicare PIN