Organization
MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Active
Parent organization
MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Other names
Pulmonary & Sleep Specialists of London
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Authorized official
KANDI R REA (CREDENTIALING SPECIALIST)
(606) 330-3404
Entity
Organization
Contact information
Practice address
1210 W 5TH ST, LONDON, KY 40741-2112
(606) 864-4030
(606) 864-0115
Mailing address
PO BOX 2638, LONDON, KY 40743-2638
(606) 330-3404
(606) 330-3100
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Enumeration date
09/16/2009
Last updated
09/17/2009
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