Organization
INTERVENTIONAL REHABILITATION OF KENTUCKY, P.S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICKY STANLEY COLLIS MD (OWNER)
(502) 589-4765
Entity
Organization
Contact information
Practice address
315 E BROADWAY, SUITE 250, LOUISVILLE, KY 40202-3700
(502) 589-4765
(502) 589-4799
Mailing address
315 E BROADWAY, SUITE 250, LOUISVILLE, KY 40202-3700
(502) 589-4765
(502) 589-4799
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1103005
—
KY
05
—
200279470A
—
IN
01
—
2322033
AETNA
—
01
—
372286700
OWCP
—
05
—
65943870
—
KY
Enumeration date
08/01/2006
Last updated
07/28/2015
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