Provider Demographics
NPI:1609558956
Name:HUMAN PERFORMANCE MEDICAL-KENTUCKY, PSC
Entity Type:Organization
Organization Name:HUMAN PERFORMANCE MEDICAL-KENTUCKY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-459-0780
Mailing Address - Street 1:3038 LONE OAK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5722
Mailing Address - Country:US
Mailing Address - Phone:484-459-0780
Mailing Address - Fax:
Practice Address - Street 1:3038 LONE OAK RD STE 4
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5722
Practice Address - Country:US
Practice Address - Phone:484-459-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty