# SUPPORTIVE MED

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

## Provider details

- **NPI number:** 1740077163
- **Authorized official:** ROBERT LEVINE (OWNER)
- **Authorized official phone:** (760) 636-8428

## Contact information

- **Practice address:** 1619 DIEDERICH BLVD STE B, RUSSELL, KY 41169-1779
- **Practice address phone:** (606) 324-0334
- **Mailing address:** 250 COLVIN LN, RACELAND, KY 41169-1286
- **Mailing address phone:** (606) 371-2369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2025
- **Last updated:** 04/21/2025