Organization
SUPPORTIVE MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LEVINE (OWNER)
(760) 636-8428
Entity
Organization
Contact information
Practice address
1619 DIEDERICH BLVD STE B, RUSSELL, KY 41169-1779
(606) 324-0334
Mailing address
250 COLVIN LN, RACELAND, KY 41169-1286
(606) 371-2369
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/21/2025
Last updated
04/21/2025
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