Provider Demographics
NPI:1528156866
Name:WEST KENTUCKY RHEUMATOLOGY,PSC
Entity type:Organization
Organization Name:WEST KENTUCKY RHEUMATOLOGY,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-534-0046
Mailing Address - Street 1:125 AUGUSTA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5584
Mailing Address - Country:US
Mailing Address - Phone:270-534-0046
Mailing Address - Fax:270-534-0048
Practice Address - Street 1:125 AUGUSTA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5584
Practice Address - Country:US
Practice Address - Phone:270-534-0046
Practice Address - Fax:270-534-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26804207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
145768OtherHEALTHLINK
KY000000049267OtherBLUE CROSS BLUE SHIELD
029602OtherHEALTH ALLIANCE
TN3145428OtherBLUE CROSS/SHIELD TN
A99158Medicare UPIN
145768OtherHEALTHLINK