Provider Demographics
NPI:1447534490
Name:ADVANCED PAIN AND WEIGHT LOSS SOLUTIONS, PSC
Entity type:Organization
Organization Name:ADVANCED PAIN AND WEIGHT LOSS SOLUTIONS, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PELFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-346-2795
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:HUSTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40437-0259
Mailing Address - Country:US
Mailing Address - Phone:606-346-2795
Mailing Address - Fax:606-346-2382
Practice Address - Street 1:133 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1084
Practice Address - Country:US
Practice Address - Phone:606-346-2795
Practice Address - Fax:606-346-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care