Provider Demographics
NPI:1962670158
Name:JOLINDA DILLOW, M.D., PSC
Entity Type:Organization
Organization Name:JOLINDA DILLOW, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-0051
Mailing Address - Street 1:PO BOX 2059
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2059
Mailing Address - Country:US
Mailing Address - Phone:606-324-0051
Mailing Address - Fax:
Practice Address - Street 1:336 29TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1900
Practice Address - Country:US
Practice Address - Phone:606-324-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32439174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG29960Medicare UPIN