# NORTHERN KENTUCKY PAIN RELIEF PHYSICAL MEDICINE CENTER PSC

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

## Provider details

- **NPI number:** 1649554031
- **Authorized official:** RICHARD M DAMMEL MD (OWNER)
- **Authorized official phone:** (513) 404-6983

## Contact information

- **Practice address:** 7560 US HWY 42, FLORENCE, KY 41042-1469
- **Practice address phone:** (859) 283-2475
- **Practice address fax:** (859) 283-0097
- **Mailing address:** 7560 US HWY 42, FLORENCE, KY 41042-1469
- **Mailing address phone:** (859) 283-2475
- **Mailing address fax:** (859) 283-0097

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/04/2011
- **Last updated:** 12/03/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6682330001 | MEDICARE DME SUPPLIER | KY |
| 05 | — | 710021850 | — | KY |
| 05 | — | 7100439820 | — | KY |
| 05 | — | 7100439880 | — | KY |