Organization
KENTUCKY BREAST CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA WOODROOF M.D. (MANAGING MEMBER)
(606) 658-9535
Entity
Organization
Contact information
Practice address
38 JOE T PETTY DRIVE, RUSSELL SPRINGS, KY 42642-8553
(606) 658-9535
(270) 866-9716
Mailing address
38 JOE T PETTEY DRIVE, RUSSELL SPRINGS, KY 42642-8553
(606) 658-9535
(270) 866-9716
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100212880
—
KY
Enumeration date
06/14/2012
Last updated
11/02/2012
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