Provider Demographics
NPI:1336997022
Name:FIRSTHAND MEDICAL OF KENTUCKY PSC
Entity type:Organization
Organization Name:FIRSTHAND MEDICAL OF KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-674-1620
Mailing Address - Street 1:1032 E BRANDON BLVD STE 4567
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:524 BROADWAY FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4471
Practice Address - Country:US
Practice Address - Phone:844-378-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health