Organization
ADULT IMMUNIZATION MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY CRABTREE (OWNER)
(270) 663-1240
Entity
Organization
Contact information
Practice address
1010 ALLEN ST, SUITE 203, OWENSBORO, KY 42303-3025
(270) 663-1240
(270) 228-4400
Mailing address
PO BOX 1221, OWENSBORO, KY 42302-1221
(270) 663-1240
(270) 228-4400
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100123610
—
KY
Enumeration date
12/11/2009
Last updated
12/02/2015
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