Provider Demographics
NPI:1447549647
Name:BULLITT COUNTY ADVANCED PAIN CENTER LLC
Entity type:Organization
Organization Name:BULLITT COUNTY ADVANCED PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-955-5328
Mailing Address - Street 1:1451 HIGHWAY 44 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-5128
Mailing Address - Country:US
Mailing Address - Phone:502-955-5328
Mailing Address - Fax:502-543-5039
Practice Address - Street 1:1451 HIGHWAY 44 E
Practice Address - Street 2:SUITE 102
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-5128
Practice Address - Country:US
Practice Address - Phone:502-955-5328
Practice Address - Fax:502-543-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty