Organization
KENTUCKY PAIN MANAGEMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP R MULLINS (CEO)
(606) 487-0776
Entity
Organization
Contact information
Practice address
311 ROY CAMPBELL DRIVE, HAZARD, KY 41701
(606) 487-0776
(606) 487-0777
Mailing address
PO BOX 1297, HAZARD, KY 41702
(606) 487-0776
(606) 487-0777
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
261QP3300X
Pain Clinic/Center
Primary
29445
KY
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000509781
ANTHEM BCBS
KY
01
—
29445
STATE LICENSE #
KY
05
—
7100002910
—
KY
Enumeration date
01/09/2007
Last updated
08/15/2015
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