| Organization Name: | EAST KY HEALTH SERVICE CENTER |
| NPI Number: | 1376648139 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BENNY RAY BAILEY (EXECUTIVE DIRECTOR) |
| Mailing Address: | 566 Highway 899 Hindman |
| State: | KY US |
| Postal Code: | 418220849 |
| Phone Number: | 6067853164 |
| Fax Number: | 6067850107 |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 03/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 6629 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |