Provider Demographics
NPI:1447278494
Name:ACE CLINIQUE OF MEDICINE
Entity type:Organization
Organization Name:ACE CLINIQUE OF MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-439-6503
Mailing Address - Street 1:PO BOX 2008
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-2008
Mailing Address - Country:US
Mailing Address - Phone:606-439-6503
Mailing Address - Fax:606-439-6503
Practice Address - Street 1:181 ROY CAMPBELL DRIVE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-0000
Practice Address - Country:US
Practice Address - Phone:606-439-6503
Practice Address - Fax:606-439-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28914291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY28914OtherMEDICAL LICENSE NUMBER
KY64289143Medicaid
KY1325505Medicare ID - Type Unspecified
F48719Medicare UPIN