Provider Demographics
NPI:1962475301
Name:KENTUCKY PAIN PHYSICIANS, PSC
Entity Type:Organization
Organization Name:KENTUCKY PAIN PHYSICIANS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF TIN/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-252-6500
Mailing Address - Street 1:7160 NORTH MAYO TRAIL
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-0000
Mailing Address - Country:US
Mailing Address - Phone:606-478-9928
Mailing Address - Fax:606-478-7001
Practice Address - Street 1:7160 NORTH MAYO TRAIL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-0000
Practice Address - Country:US
Practice Address - Phone:606-478-9928
Practice Address - Fax:606-478-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472800Medicaid
WV3810003494Medicaid
KYCD2933OtherRR MEDICARE
KY65926552Medicaid