Provider Demographics
NPI:1619066057
Name:EAST KENTUCKY AFTER HOURS CLINIC PLLC
Entity Type:Organization
Organization Name:EAST KENTUCKY AFTER HOURS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-205-9361
Mailing Address - Street 1:255 CHURCH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3476
Mailing Address - Country:US
Mailing Address - Phone:606-205-9361
Mailing Address - Fax:606-789-7117
Practice Address - Street 1:255 CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3476
Practice Address - Country:US
Practice Address - Phone:606-205-9361
Practice Address - Fax:606-789-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty