Organization
ELITE EMERGENCY SERVICES OF KENTUCKY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL C. CLEMMONS M.D. (PRESIDENT)
(615) 928-6275
Entity
Organization
Contact information
Practice address
100 MEDICAL CENTER DR, PRINCETON, KY 42445-2430
(270) 365-0438
Mailing address
PO BOX 4458, DEPT 176, HOUSTON, TX 77210-4458
(866) 434-8164
(615) 760-5985
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
204R00000X
Electrodiagnostic Medicine Physician
—
—
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100200270
—
KY
Enumeration date
03/19/2012
Last updated
08/16/2018
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