Organization
PEDIATRIC ASSOCIATES
Active
Other names
Red River Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
DJIEN HWAT SO (OPERATING MANAGER)
(606) 432-0174
Entity
Organization
Contact information
Practice address
321C E COLLEGE AVE, STANTON, KY 40380-2325
(606) 663-9797
(606) 663-9470
Mailing address
PO BOX 2748, PIKEVILLE, KY 41502-2748
(606) 432-3221
(606) 437-0438
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
900183
KY
261QR1300X
Rural Health Clinic/Center
Primary
900183
KY
363A00000X
Physician Assistant
PA1161
KY
363LF0000X
Family Nurse Practitioner
3006123
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35001783
—
KY
Enumeration date
06/01/2006
Last updated
03/21/2017
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