| Kentucky Medical Spa | |
|
636 Jefferson Ave Paintsville KY 41240-1349 | |
| (606) 788-1035 | |
| (606) 788-1045 |
| Full Name | Kentucky Medical Spa |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 636 Jefferson Ave, Paintsville, Kentucky |
| Authorized Official Name and Position | Jerry Brackett (PRESIDENT) |
| Authorized Official Contact | 6067881035 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky Medical Spa Po Box 2710 Paintsville KY 41240-6710 Ph: (606) 788-1035 | Kentucky Medical Spa 636 Jefferson Ave Paintsville KY 41240-1349 Ph: (606) 788-1035 |
| NPI Number | 1326440637 |
|---|---|
| Provider Enumeration Date | 09/17/2014 |
| Last Update Date | 09/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326440637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 14390 (Kentucky) | Primary |
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