Central Kentucky Interventional Pain Center, PLLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

CENTRAL KENTUCKY INTERVENTIONAL PAIN CENTER, PLLC

Practice address

300 W Broadway St
Danville, KY 40422-1408

Phone

(859) 236-0606

Fax

(859) 236-0066

NPI assigned

Jul 18, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Khursheed Siddiqui, MD

Title

Owner/Group President

Phone

(859) 236-0606

Specialties & licenses 4

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514419200000",
    "number": "1407855935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7096",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670096",
            "telephone_number": "209-956-7725",
            "fax_number": "209-956-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY ST",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404221408",
            "telephone_number": "859-236-0606",
            "fax_number": "859-236-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL KENTUCKY INTERVENTIONAL PAIN CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2017-12-28",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "KHURSHEED",
        "authorized_official_title_or_position": "OWNER/GROUP PRESIDENT",
        "authorized_official_telephone_number": "859-236-0606",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "28741",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65942906",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine Physician in Danville, KY
• Providers in Danville, KY by specialty
• Pain Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.