Provider Demographics
NPI:1851581292
Name:MEDICAL SYSTEMS MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MEDICAL SYSTEMS MANAGEMENT, INC.
Other - Org Name:A NEW LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-582-5555
Mailing Address - Street 1:PO BOX 4758
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-0758
Mailing Address - Country:US
Mailing Address - Phone:502-582-5555
Mailing Address - Fax:502-582-5556
Practice Address - Street 1:720 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1750
Practice Address - Country:US
Practice Address - Phone:502-582-5555
Practice Address - Fax:502-582-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85041374Medicaid
KY07735Medicare PIN