Provider Demographics
NPI:1760111553
Name:SOUTHERN KENTUCKY VASCULAR CLINIC PLLC
Entity Type:Organization
Organization Name:SOUTHERN KENTUCKY VASCULAR CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-392-9746
Mailing Address - Street 1:50 MEDPARK SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1708
Mailing Address - Country:US
Mailing Address - Phone:606-531-4100
Mailing Address - Fax:
Practice Address - Street 1:50 MEDPARK SQUARE DR STE 3
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1708
Practice Address - Country:US
Practice Address - Phone:606-531-4100
Practice Address - Fax:606-220-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty