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Organization

JO-ANN N. BOLLI, M. D., P.S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JO-ANN NADEAU BOLLI M.D. (OWNER)
(270) 653-4070
Entity
Organization

Contact information

Practice address
308 S WASHINGTON ST, SUITE 201, CLINTON, KY 42031-1340
(270) 653-4070
(270) 653-4007
Mailing address
308 S WASHINGTON ST STE 201, P. O. BOX 123, CLINTON, KY 42031-1347
(270) 653-4070
(270) 653-4007

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
28789
KY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
28789
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
64287899
KY
Enumeration date
01/07/2013
Last updated
01/07/2013
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