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Organization

EASTERN KENTUCKY PAIN MANAGEMENT CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRAD HAMBLEN (MEMBER)
(859) 746-2444
Entity
Organization

Contact information

Practice address
1694 NORTHGATE DR, RICHMOND, KY 40475-1066
(859) 626-7755
(859) 626-7766
Mailing address
1694 NORTHGATE DR, RICHMOND, KY 40475-1066
(859) 626-7755
(859) 626-7766

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
332B00000X
Durable Medical Equipment & Medical Supplies
363A00000X
Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100095660
KY
Enumeration date
10/21/2009
Last updated
05/26/2011
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