Ira B Potter PSC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

IRA B POTTER PSC

Practice address

77 Millard Allen Dr.
Lackey, KY 41643-0190

Phone

(606) 358-2381

Fax

(606) 358-2404

NPI assigned

Jul 18, 2005

Organization subpart

No

Name

Ira Blaine Potter, MDNPI 1942208590

Title

President

Phone

(606) 358-2381

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ira Blaine Potter, MD

  • Family Medicine Physician
  • MC Dowell, KY
  • NPI 1942208590
  NPD Authorized official
• Maryann Hall, PAC

  • Physician Assistant
  • Lackey, KY
  • NPI 1245238518
  NPD (past)
• Samantha A. Little, PA-C

  • Physician Assistant
  • Lackey, KY
  • NPI 1811326812
  NPD (past)
• Keith Phillip Webb, MD

  • Internal Medicine Physician
  • McMinnville, TN
  • NPI 1003813874
  NPD (past)
• Sonja Terry Webb, M.D.

  • Pediatrics Physician
  • McMinnville, TN
  • NPI 1336147776
  NPD (past)

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 21, 2016.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458518400000",
    "number": "1962401455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "address_2": "77 MILLARD ALLEN DRIVE",
            "city": "LACKEY",
            "state": "KY",
            "postal_code": "416430190",
            "telephone_number": "606-358-2381",
            "fax_number": "606-358-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 MILLARD ALLEN DR.",
            "city": "LACKEY",
            "state": "KY",
            "postal_code": "416430190",
            "telephone_number": "606-358-2381",
            "fax_number": "606-358-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRA B POTTER PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2016-03-21",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "IRA",
        "authorized_official_middle_name": "BLAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-358-2381",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1587",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000057539",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65901399",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayne Gravitt, RPH
• Maryann Hall, PAC
• J & M Transprortation LLC
• Layne Medical, Inc.
• Samantha A. Little, PA-C
• Kelsey Darah Stiltner

• All providers in Lackey, KY
• Medical Specialty Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2016; 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.