Provider Demographics
NPI:1710219019
Name:SOUTHERN KENTUCKY MEDICINE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTHERN KENTUCKY MEDICINE ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-376-7600
Mailing Address - Street 1:990 WILKINSON TRCE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3404
Mailing Address - Country:US
Mailing Address - Phone:270-781-4043
Mailing Address - Fax:270-781-4196
Practice Address - Street 1:990 WILKINSON TRCE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3404
Practice Address - Country:US
Practice Address - Phone:270-781-4043
Practice Address - Fax:270-781-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty