Organization
BHATRAJU MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN MAYNARD PA-C (PA-MANAGER)
(606) 432-0168
Entity
Organization
Contact information
Practice address
180 TOWN MOUNTAIN RD, SUITE 111, PIKEVILLE, KY 41501-1698
(606) 432-0168
Mailing address
180 TOWN MOUNTAIN RD, SUITE 111, PIKEVILLE, KY 41501-1698
(606) 432-0168
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
PA953
KY
208VP0014X
Interventional Pain Medicine Physician
Primary
PA953
KY
Other
Enumeration date
03/23/2009
Last updated
03/23/2009
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