# KENTUCKY PAIN MANAGEMENT SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588771042
- **Authorized official:** MR. RANDY MULLINS (CEO)
- **Authorized official phone:** (606) 476-9842

## Contact information

- **Practice address:** 15 MONTGOMERY CREEK RD, VICCO, KY 41773
- **Practice address phone:** (606) 476-9842
- **Mailing address:** PO BOX 129, VICCO, KY 41773-0129
- **Mailing address phone:** (606) 476-9842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | Yes |
| 174400000X | Specialist | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 08/22/2020