NPIMap

Organization Active NPI

Tri-State Advanced Pain Management PLLC

  • Interventional Pain Medicine Physician
  • Owensboro, KY
National Provider Identifier
1922186378
Registry record updated Apr 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
TRI-STATE ADVANCED PAIN MANAGEMENT PLLC
Practice address
3332 Villa PT Ste 104
Owensboro, KY 42303-7818
Phone
(270) 684-5679
Fax
(270) 684-5753
NPI assigned
Nov 2, 2006
Last updated
Apr 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2018

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

Authorized official

Name
Suk Ki Kim, MDNPI 1477557270
Title
President
Phone
(270) 684-5679

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X NU Primary

Addresses

Primary practice location

3332 Villa PT Ste 104
Owensboro, KY 42303-7818

Mailing address

3332 Villa PT
Suite 104
Owensboro, KY 42303-7818
Phone (270) 684-5679

Other identifiers 2

IdentifierTypeStateIssuer
200426500AMedicaidIN
64177280MedicaidKY

National Provider Directory

National Provider Directory

Locations

922 Triplett St
Ste 2
Owensboro, KY 42303
Phone (270) 684-5679

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1922186378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3332 VILLA PT",
            "address_2": "SUITE 104",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423037818",
            "telephone_number": "270-684-5679",
            "fax_number": "270-684-5753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 VILLA PT STE 104",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423037818",
            "telephone_number": "270-684-5679",
            "fax_number": "270-684-5753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE ADVANCED PAIN MANAGEMENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUK",
        "authorized_official_middle_name": "KI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-684-5679",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200426500A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64177280",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.