Provider Demographics
NPI:1871643650
Name:FLYNN AND PETROSKY PSC
Entity Type:Organization
Organization Name:FLYNN AND PETROSKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-677-9250
Mailing Address - Street 1:340 BOGLE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2892
Mailing Address - Country:US
Mailing Address - Phone:606-677-9250
Mailing Address - Fax:
Practice Address - Street 1:340 BOGLE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2892
Practice Address - Country:US
Practice Address - Phone:606-677-9250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933749Medicaid
KY6691Medicare ID - Type Unspecified