Organization
EASTERN KY HEATLHCARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK KENDRICK MD (PHYSICIAN)
(606) 478-4287
Entity
Organization
Contact information
Practice address
8535 KY RT 122, MINNIE, KY 41651
(606) 478-4287
(606) 478-4288
Mailing address
PO BOX 100, MINNIE, KY 41651-0100
(606) 478-4287
(606) 478-4288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29774
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65941668
—
KY
01
—
ANTHEM BLUE CROSS
000000336367
KY
01
—
DD7592
PALMETTO GBA
KY
Enumeration date
02/26/2007
Last updated
08/22/2020
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