Provider Demographics
NPI:1619304581
Name:JEFFERY L CREECH PSC
Entity Type:Organization
Organization Name:JEFFERY L CREECH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:O,D
Authorized Official - Phone:859-987-2292
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40362-0162
Mailing Address - Country:US
Mailing Address - Phone:859-987-2292
Mailing Address - Fax:859-987-2302
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2006
Practice Address - Country:US
Practice Address - Phone:859-987-2292
Practice Address - Fax:859-987-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY799DT261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77007995Medicaid
KY9246101Medicare PIN
KY77007995Medicaid
KYT54737Medicare UPIN