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Organization

COMMONWEALTH OF KENTUCKY

Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Outwood Specialty Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
COMMONWEALTH OF KENTUCKY
Authorized official
WENDY MORRIS (DEPUTY COMMISSIONER)
(502) 564-4527
Entity
Organization

Contact information

Practice address
23524 DAWSON SPRINGS RD, DAWSON SPRINGS, KY 42408-9205
(270) 797-3771
(270) 797-3592
Mailing address
23524 DAWSON SPRINGS RD, DAWSON SPRINGS, KY 42408-9205
(270) 797-3771
(270) 797-3592

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary

Other

Enumeration date
04/11/2014
Last updated
04/11/2014
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