Organization
KENTUCKY EM-I MEDICAL SERVICES, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
5000 KY ROUTE 321, PRESTONSBURG, KY 41653-9113
(606) 886-8511
Mailing address
PO BOX 42966, PHILADELPHIA, PA 19101-2966
(800) 355-0808
(610) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65930539
—
KY
Enumeration date
07/17/2007
Last updated
07/17/2007
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