Organization
EASTERN KY TENDER CARE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTOIN HANA M.D. (OWNER)
(606) 886-7517
Entity
Organization
Contact information
Practice address
5000 KY ROUTE 321, SUITE 3141, PRESTONSBURG, KY 41653-9113
(606) 886-7517
(606) 886-7524
Mailing address
PO BOX 697, PRESTONSBURG, KY 41653-0697
(606) 886-7517
(606) 886-7524
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000260816
ANTHEM BCBS
KY
Enumeration date
08/09/2005
Last updated
08/22/2020
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