# IRA B POTTER PSC

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

## Provider details

- **NPI number:** 1962401455
- **Authorized official:** IRA BLAINE POTTER MD (PRESIDENT)
- **Authorized official phone:** (606) 358-2381

## Contact information

- **Practice address:** 77 MILLARD ALLEN DR., LACKEY, KY 41643-0190
- **Practice address phone:** (606) 358-2381
- **Practice address fax:** (606) 358-2404
- **Mailing address:** PO BOX 190, 77 MILLARD ALLEN DRIVE, LACKEY, KY 41643-0190
- **Mailing address phone:** (606) 358-2381
- **Mailing address fax:** (606) 358-2404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |
| 363A00000X | Physician Assistant | PA1587 | KY | — |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 03/21/2016