| Psc A Sub S Corporation | |
|
87 Wildwood Place Irvine KY 40336-1312 | |
| (606) 723-3213 | |
| (606) 723-3213 |
| Full Name | Psc A Sub S Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 87 Wildwood Place, Irvine, Kentucky |
| Authorized Official Name and Position | Jimmie Lee Johnson (DENTIST) |
| Authorized Official Contact | 6067233213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psc A Sub S Corporation Po Box 175 87 Wildwood Place Irvine KY 40336-1312 Ph: (606) 723-3213 | Psc A Sub S Corporation 87 Wildwood Place Irvine KY 40336-1312 Ph: (606) 723-3213 |
| NPI Number | 1578605978 |
|---|---|
| Provider Enumeration Date | 02/13/2007 |
| Last Update Date | 03/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578605978 | NPI | - | NPPES |
| 60061637 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6163 (Kentucky) | Primary |
Irvine Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 934 Richmond Rd, Irvine, KY 40336 Phone: 606-723-1000 Fax: 606-723-1039 | |
Kentucky River Dentistry, Psc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 161 Richmond Rd, Irvine, KY 40336 Phone: 606-723-4112 Fax: 606-723-5372 |