East Ky Health Service Center
Organization Active NPI Primary Care Nurse Practitioner · Hindman, KY
NPI 1376648139 · NPPES record last updated Jun 10, 2021
Key facts
- NPI
- 1376648139
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 3008325 (KY)
- Legal business name
- EAST KY HEALTH SERVICE CENTER
- Practice address
- 566 Highway 899
Hindman, KY 41822-0849 - Phone
- (606) 785-3164
- Fax
- (606) 785-0107
- NPI assigned
- Sep 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Benny Ray Bailey, PH.D.
- Title
- Executive Director
- Phone
- (606) 785-3164
Other NPIs with the same Medicare PAC ID 1
Practitioners 4
-
Jaimee Jones, APRN
-
Melissa Moore, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050421001269 | KY | Part B Supplier - Clinic/Group Practice | 6901844711 |
Receives reassigned benefits from 4 practitioners Practice locations: Hindman, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 6629 | KY | |
| Primary Care Clinic/Center | 261QP2300X | 700002 | KY | |
| Primary Care Nurse Practitioner |
363LP2300X | 3008325 | KY | Yes |
Addresses
Primary practice location
566 Highway 899
Hindman, KY 41822-0849
Mailing address
PO Box 849
566 Hwy 899
Hindman, KY 41822-0849
Phone (606) 785-3164
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65924300 | Medicaid | KY |
Other providers in Hindman, KY
- Kevin Davis
- Zachary Davis
- Dustin Combs PLLC
- East Kentucky Health Service
- East Kentucky Pharmacy Inc
- East Ky Health Service Center
- East Ky Health Service Center
- Eastern Kentucky Comprehensive Care, PLLC
- Evercare, LLC
- Jaime Janeille Fields
All providers in Hindman, KY · Primary Care Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.