Provider Demographics
NPI:1770935041
Name:LAUREL COUNTY PHYSIATRY AND PAIN LLC
Entity type:Organization
Organization Name:LAUREL COUNTY PHYSIATRY AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-260-8345
Mailing Address - Street 1:130 THOMPSON POYNTER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7280
Mailing Address - Country:US
Mailing Address - Phone:606-260-8345
Mailing Address - Fax:606-260-8352
Practice Address - Street 1:130 THOMPSON POYNTER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7280
Practice Address - Country:US
Practice Address - Phone:606-260-8345
Practice Address - Fax:606-260-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY340562081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK207940Medicare PIN