Provider Demographics
NPI:1750323366
Name:CENTRAL KENTUCKY PAIN PROFESSIONALS, PLLC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY PAIN PROFESSIONALS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-276-0100
Mailing Address - Street 1:2628 WILHITE CT
Mailing Address - Street 2:STE 101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3327
Mailing Address - Country:US
Mailing Address - Phone:859-276-0100
Mailing Address - Fax:859-277-1115
Practice Address - Street 1:2628 WILHITE CT
Practice Address - Street 2:STE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3327
Practice Address - Country:US
Practice Address - Phone:859-276-0100
Practice Address - Fax:859-277-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940827Medicaid
KY9056Medicare ID - Type Unspecified