Provider Demographics
NPI:1649554031
Name:NORTHERN KENTUCKY PAIN RELIEF PHYSICAL MEDICINE CENTER PSC
Entity type:Organization
Organization Name:NORTHERN KENTUCKY PAIN RELIEF PHYSICAL MEDICINE CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-404-6983
Mailing Address - Street 1:7560 US HWY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1469
Mailing Address - Country:US
Mailing Address - Phone:859-283-2475
Mailing Address - Fax:859-283-0097
Practice Address - Street 1:7560 US HWY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1469
Practice Address - Country:US
Practice Address - Phone:859-283-2475
Practice Address - Fax:859-283-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100439880Medicaid
KY6682330001OtherMEDICARE DME SUPPLIER
KY7100439820Medicaid
KY710021850Medicaid