Organization
PENNY MEDICINEBEAR
Active
Other names
arrive alive
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL FUQUA MEDICINEBEAR N/A (CO-OWNER)
(270) 784-7079
Entity
Organization
Contact information
Practice address
324 SUNSET AVE, SMITHS GROVE, KY 42171-8164
(270) 784-7079
(270) 451-1200
Mailing address
PO BOX 433, 324 SUNSET AVE, SMITHS GROVE, KY 42171-0433
(270) 784-7079
(270) 451-1200
Taxonomy
Speciality
Code
Description
License number
State
344600000X
Taxi
Primary
3585
KY
344600000X
Taxi
3586
KY
Other
Enumeration date
05/04/2010
Last updated
05/04/2010
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