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Organization
DANVILLE MEDICAL PRACTICE PLLC
Active
Organization
DANVILLE MEDICAL PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY D BOURNE (OFFICE MANAGER)
(859) 936-2020
Entity
Organization
Contact information
Practice address
416A W WALNUT ST, DANVILLE, KY 40422
(859) 936-2020
(859) 936-7424
Mailing address
416A W WALNUT ST, DANVILLE, KY 40422
(859) 936-2020
(859) 936-7424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000313483
BC GROUP #
KY
05
—
65940082
—
KY
01
—
DB4203
RAILROAD MEDICARE
KY
Enumeration date
09/20/2006
Last updated
11/21/2007
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