Organization
EAST KY HEALTH SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENNY RAY BAILEY PH D (EXECUTIVE DIRECTOR)
(606) 785-3164
Entity
Organization
Contact information
Practice address
566 HIGHWAY 899 # 849, HINDMAN, KY 41822-8955
(606) 785-3164
Mailing address
PO BOX 849, HINDMAN, KY 41822-0849
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65924300
—
KY
Enumeration date
05/28/2019
Last updated
06/10/2021
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