Organization
FIVCO ADD CDO AS FISCAL AGENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY MCDAVID (EXECUTIVE DIRECTOR)
(606) 929-1366
Entity
Organization
Contact information
Practice address
1212 BATH AVE, SUITE 650, ASHLAND, KY 41101-2696
(606) 929-1366
(606) 327-0023
Mailing address
1212 BATH AVE, SUITE 650, ASHLAND, KY 41101-2696
(606) 929-1366
(606) 327-0023
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17000811
—
KY
05
—
33001447
—
KY
05
—
43996107
—
KY
Enumeration date
05/29/2007
Last updated
08/22/2020
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