Organization
EAST TENNESSEE WOUND CARE PC
Active
Other names
Rolyn PSC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARY THOMAS KIRK M.D. (SOLE OWNER)
(502) 930-9861
Entity
Organization
Contact information
Practice address
4950 NORTON HEALTHCARE BLVD, SUITE 101, LOUISVILLE, KY 40241-2845
(502) 446-6160
Mailing address
PO BOX 8180, LOUISVILLE, KY 40257-8180
(502) 753-0680
(502) 753-0687
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
21368
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000487847
ANTHEM BLUE CROSS BLUE SHIELD
KY
05
—
200828020A
—
IN
01
—
2789407000
PASSPORT ADVANTAGE
KY
01
—
50012967
PASSPORT HEALTH PLANS
KY
01
—
DF7517
RAILROAD MEDICARE
KY
Enumeration date
02/09/2007
Last updated
06/20/2013
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