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Organization
SOUTHERN KENTUCKY MEDICAL ASSOCIATES, PSC
Active
Organization
SOUTHERN KENTUCKY MEDICAL ASSOCIATES, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CUNDIFF-ROY (PRESIDENT)
(270) 866-4357
Entity
Organization
Contact information
Practice address
72 JOE T. PETTEY DR, RUSSELL SPRINGS, KY 42642
(270) 866-4357
Mailing address
PO BOX 1383, RUSSELL SPRINGS, KY 42642-1383
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
01/10/2011
Last updated
02/14/2011
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