Provider Demographics
NPI:1902147713
Name:EAST KY CLINIC
Entity Type:Organization
Organization Name:EAST KY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LOEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-789-6086
Mailing Address - Street 1:538 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1046
Mailing Address - Country:US
Mailing Address - Phone:606-789-6086
Mailing Address - Fax:606-789-3811
Practice Address - Street 1:538 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-6086
Practice Address - Fax:606-789-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty