Provider Demographics
NPI:1902123870
Name:ADVANCED PAIN AND WEIGHT LOSS SOLUTIONS PSC
Entity Type:Organization
Organization Name:ADVANCED PAIN AND WEIGHT LOSS SOLUTIONS PSC
Other - Org Name:ADVANCED CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OFFICE OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PELFREY
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, AS, CMA (AAMA)
Authorized Official - Phone:859-539-1339
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:66 ISAIAH DRIVE STE 2
Mailing Address - City:HUSTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40437-0259
Mailing Address - Country:US
Mailing Address - Phone:859-539-1339
Mailing Address - Fax:
Practice Address - Street 1:66 ISAIAH LANE
Practice Address - Street 2:STE 2
Practice Address - City:HUSTONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40437-0259
Practice Address - Country:US
Practice Address - Phone:606-346-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5466P261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center