Provider Demographics
NPI:1447449350
Name:KYLE D PARISH MD PSC
Entity type:Organization
Organization Name:KYLE D PARISH MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-443-0010
Mailing Address - Street 1:1532 LONE OAK RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7913
Mailing Address - Country:US
Mailing Address - Phone:270-443-0010
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 305
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-443-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38909207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty