Provider Demographics
NPI:1396949756
Name:BALLARD COUNTY MEDICAL CENTER, PSC
Entity type:Organization
Organization Name:BALLARD COUNTY MEDICAL CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY AND CPA
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TREECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-534-8999
Mailing Address - Street 1:PO BOX 7287
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7287
Mailing Address - Country:US
Mailing Address - Phone:270-534-8999
Mailing Address - Fax:270-534-1670
Practice Address - Street 1:120 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:KY
Practice Address - Zip Code:42024
Practice Address - Country:US
Practice Address - Phone:270-534-8999
Practice Address - Fax:270-534-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty