Provider Demographics
NPI:1245686245
Name:PAINTSVILLE PRIMARY CARE AND SPA
Entity type:Organization
Organization Name:PAINTSVILLE PRIMARY CARE AND SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OFFIC MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-788-1035
Mailing Address - Street 1:636 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1349
Mailing Address - Country:US
Mailing Address - Phone:606-788-1035
Mailing Address - Fax:606-788-1458
Practice Address - Street 1:636 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1349
Practice Address - Country:US
Practice Address - Phone:606-788-1035
Practice Address - Fax:606-788-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care