Provider Demographics
NPI:1902827009
Name:KENTENN MEDICAL PSC
Entity Type:Organization
Organization Name:KENTENN MEDICAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-886-0829
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0525
Mailing Address - Country:US
Mailing Address - Phone:270-886-0829
Mailing Address - Fax:270-885-6468
Practice Address - Street 1:114 KEETON DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8756
Practice Address - Country:US
Practice Address - Phone:270-886-0829
Practice Address - Fax:270-885-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711024Medicare PIN