Organization
EASTERN KENTUCKY TENDER CARE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOIN HANA M.D. (OWNER)
(606) 886-1173
Entity
Organization
Contact information
Practice address
400 UNIVERSITY DR STE 101, PRESTONSBURG, KY 41653-1080
(606) 886-1173
(606) 886-2193
Mailing address
PO BOX 697, PRESTONSBURG, KY 41653-0697
(606) 886-1173
(606) 886-2193
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100006320
—
KY
Enumeration date
04/19/2007
Last updated
02/24/2021
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