Provider Demographics
NPI:1679197529
Name:KENTUCKY MOUNTAIN INTERVENTIONAL AND INFUSION THERAPIES, LLC.
Entity Type:Organization
Organization Name:KENTUCKY MOUNTAIN INTERVENTIONAL AND INFUSION THERAPIES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:606-433-0404
Mailing Address - Street 1:101 HIBBARD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1788
Mailing Address - Country:US
Mailing Address - Phone:606-433-0404
Mailing Address - Fax:606-432-0405
Practice Address - Street 1:101 HIBBARD ST STE 200
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1788
Practice Address - Country:US
Practice Address - Phone:606-433-0404
Practice Address - Fax:606-432-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty