Provider Demographics
NPI:1902027865
Name:MY 3 C'S ENTERPRISES, PLLC
Entity Type:Organization
Organization Name:MY 3 C'S ENTERPRISES, PLLC
Other - Org Name:MY 3 C'S ENTERPRISES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:DUNAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:270-432-4800
Mailing Address - Street 1:1704 W STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8137
Mailing Address - Country:US
Mailing Address - Phone:270-432-4800
Mailing Address - Fax:270-432-4804
Practice Address - Street 1:1704 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8137
Practice Address - Country:US
Practice Address - Phone:270-432-4800
Practice Address - Fax:270-432-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35818208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000259528OtherBLUE CROSS
KY64029440Medicaid
KY000000259528OtherANTHEM
KY0751201Medicare ID - Type Unspecified
KY7512Medicare ID - Type Unspecified
KY000000259528OtherANTHEM